Lasting Power of Attorney Questionnaire
This questionnaire will provide us with some of the information required to draft the LPAs for an individual, or for a couple. We will discuss this in detail at your interview, but it may help you to know what information we require. If there is anything you are unsure about, please do not worry and just leave it blank.
Personal Details
Please list the details for your chosen attorneys below. Please also confirm whether
How are your Attorney(s) to act – to be completed at appointment
You need to choose whether your attorneys can make decisions on their own or must agree some or all decisions unanimously. Whatever you choose, they must always act in your best interests.
Please indicate below how you would like your Attorney(s) to act.
Jointly
Jointly and severally
Jointly for some decisions, jointly and severally for other decisions
Will you appoint any replacement attorney(s) to act on your behalf in the event of one or more of your attorneys is unable to act on your behalf? If so then please provide their details below and confirm how they will act on your behalf.
Please indicate below how you would like your Replacement Attorney(s) to act.
Jointly
Jointly and severally
Jointly for some decisions, jointly and severally for other decisions
Registration and making decisions
When making your LPA you will need to confirm when your Attorney(s) can act on your behalf. Your Attorney(s) may act on your behalf as soon as your LPA is registered or only when and if you lost mental capacity. Please confirm which option you would prefer below, we will discuss this in your meeting, please leave it blank if you need advice before making a decision.
As soon as my LPA has been registered (and also when I don’t have mental capacity)
Only When I don’t have Mental capacity
When making your LPA you are given the option to let people know that you’re going to register your LPA. They can raise any concerns they have about the LPA – for example if there was any pressure or fraud in making it. When the LPA is registered, the person applying to register (you or one of your attorneys) must send a notice to each ‘person to notify’.
You cannot notify your Attorney(s) in this section.
Please note should you wish for us to Notify anyone on your behalf, that person has the option of your LPA being registered. These include by are not limited to, your lack of capacity to make the LPA, fraud, the LPA being canceled by you, or attorneys acting against your best interest.
If you would like to Notify someone, then please provide me with their details below.
Preferences and Instructions
You can tell your attorneys how you’d prefer them to make decisions or give them specific instructions which they must follow when making decisions. Most people leave this page blank – you can just talk to your attorneys so they understand how you want them to make decisions for you.
Be careful – if you give instructions that are not legally correct they would have to be removed before your LPA could be registered. It can also restrict what your attorney(s) can and can't do on your behalf.
If you have any Preferences or Instructions for your Attorney(s) then please detail them below. We will discuss these during your meeting.
Life Sustaining Treatment – Health and Welfare LPA only
You must choose whether your attorneys can give or refuse consent to life-sustaining treatment on your behalf. Life-sustaining treatment means care, surgery, medicine, or other help from doctors that are needed to keep you alive, for example, a serious operation, such as a heart bypass or organ transplant, cancer treatment, artificial nutrition or hydration (food or water given other than by mouth). Whether some treatments are life-sustaining depends on the situation. If you had pneumonia, a simple course of antibiotics could be life-sustaining. Decisions about life-sustaining treatment can be needed in unexpected circumstances, such as a routine operation that didn’t go as planned.
You must decide whether your Attorney has the power to give or take away life-sustaining treatment or whether this decision will be left to your doctors. This is a personal choice, we will be able to advise you further in the meeting.
Attorneys have the authority to give or take away life sustaining treatment.
Attorneys DO NOT have the authority to give or take away life sustaining treatment.
