A Wisconsin medical power of attorney form lets you, the principal, name an agent to make health care decisions for you if you cannot make them yourself. Wisconsin's statutes call this document a power of attorney for health care.[1] The free FormsPal form below walks you through the fields, and this guide explains how to sign it.
Last Updated: October 2026. This guide is reviewed and updated regularly to reflect current Wisconsin law. If you notice an error or outdated information, please contact us.
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Wisconsin power of attorney templates – visit for additional Wisconsin-specific power of attorney forms that you might require.
In Wisconsin, a valid power of attorney for health care must be in writing, dated and signed by the principal, signed in the presence of 2 witnesses, and voluntarily executed.[1] These rules come from Wis. Stat. § 155.10, and the list below puts each one in plain words. Under Wis. Stat. § 155.05, you may voluntarily execute a power of attorney for health care if you are of sound mind and have attained age 18.[2]
A medical power of attorney names the person who speaks for you on health care. Part II of the FormsPal template is an advance directive, so one document names your agent and records your wishes. Advance directives are one part of advance care planning. For a general explanation of the document, see our medical power of attorney form guide.
The witness age rule in the statute reads:
A witness to the execution of a valid power of attorney for health care instrument shall be an individual who has attained age 18.
Do not sign alone. The form must be signed in the presence of 2 witnesses, so gather both before you sign.[1]
Whoever you choose as your agent, talk with that person before you sign. Your agent can only follow the wishes your agent knows about.
The statutory form in Wis. Stat. § 155.30 includes a Statement of Health Care Agent and Alternate Health Care Agent. In it, your agent and your alternate agent each state that they understand you have designated them, and that you have discussed your desires regarding health care decisions with them.[3]
Under Wis. Stat. § 155.50(1), no health care facility or health care provider may be charged with a crime, held civilly liable or charged with unprofessional conduct for the acts that subsection lists. Under § 155.70(1)(a), a health care decision made on your behalf under your power of attorney for health care does not, for any purpose, constitute suicide.[3]
The form can be revoked by tearing, burning, defacing or obliterating it, by a signed writing, or verbally before two witnesses.[4]
| Document Name | Wisconsin Medical Power of Attorney Form |
| Name in Wisconsin Law | Power of attorney for health care[1] |
| State Law | Wis. Stat. § 155.10[1], in chapter 155, sections 155.01 to 155.80[3] |
| Signing Requirements | In writing, dated, signed by the principal, in the presence of 2 witnesses[1] |
| Witnesses | Each witness is an individual who has attained age 18[1] |
| Voluntary | The form must be voluntarily executed[1] |
| Who Can’t Be the Agent? | Your health care provider, an employee of that provider, an employee of a health care facility where you are a patient or live, or the spouse of any of them, unless that person is your relative[2] |
| # of Fillable Fields | 29 |
| Available Formats | Adobe PDF |
Popular Local Medical POA Forms
HCPOA forms enable you to establish a representative who can manage your health-related affairs after you end up incapacitated. These are the states MPOA forms are requested in most often.
The FormsPal Wisconsin medical power of attorney template has 29 fillable fields across nine form pages. You fill in your name and address, your agent and an alternate agent, your signature, the notary acknowledgment, and the two witness blocks. Everything else is preprinted, including the agent's powers in Part I, the Advance Health Care Directive in Part II, and the general provisions in Part III. If you prefer to type on screen, you can fill out the PDF online after you download it.
The screenshots under each step show the FormsPal Wisconsin medical power of attorney template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.
To put your Wisconsin medical power of attorney to use, print the form, fill it in, and sign and date it with both witnesses present. Wisconsin's statute requires the instrument to be signed in the presence of 2 witnesses.[1] After that, share copies with the people who will rely on it and keep the original where your agent can find it.
These answers cover the signing rules that Wis. Stat. § 155.10 sets for a medical power of attorney in Wisconsin, plus one question about the FormsPal template. Each legal answer cites the statute listed under Sources.
Fill out the form on this page, print it, then sign and date it. The statute says the instrument must be in writing, signed in the presence of 2 witnesses, and voluntarily executed.[1]
Two. Both must be present when you sign, and each must be an individual who has attained age 18.[1]
Only in the way the statute describes. You sign, or an individual who has attained age 18 signs at your express direction and in your presence.[1]
Yes. Page 7 has a notary acknowledgment with lines for the county, the date, the officer's name and title, your name, and the notary's signature and seal. The witness blocks are on page 9.
Other Medical POA Forms by State
The free FormsPal Wisconsin medical power of attorney template has 29 fillable fields across nine form pages. Fill it in with the form at the top of this page, then download and print it. Remember that the form must be signed in the presence of 2 witnesses.[1] To change the PDF later, use our PDF editor.
General information, not legal or tax advice.
