Post-Consultation Form

The Personal representative is the person who would manage your affairs in the event of your death or incapacitation.  Most people choose a spouse, close relative or close friend.  This person would notify TheraClosure of the event so that we can immediately begin notifying your <clients/patients>, helping your <clients/patients> find referrals for ongoing care, and managing your practice.  The alternate personal representative would take on the same role in the event that the personal representative is not available. Please be sure that you have discussed these roles with your personal and alternate representatives and have confirmed that they accept the roles.  Note that, once the Professional Will is signed, TheraClosure will email your personal and alternative representatives to introduce ourselves and ensure they have our emergency contact information.

The Personal representative is the person who would manage your affairs in the event of your death or incapacitation.  Most people choose a spouse, close relative or close friend.  This person would notify TheraClosure of the event so that we can take custody of your clinical records.  The alternate personal representative would take on the same role in the event that the personal representative is not available. Please be sure that you have discussed these roles with your personal and alternate representatives and have confirmed that they accept the roles.  Note that, once the Professional Will is signed, TheraClosure will email your personal and alternative representatives to introduce ourselves and ensure they have our emergency contact information.

Post-Consultation Form

The Personal representative is the person who would manage your affairs in the event of your death.  The alternative personal representative would take on the same role in the event that the personal representative is not available.  Most people choose a spouse, close relative or close friend.  This person would notify TheraClosure of your death.  If you elected TheraClosure to notify any <clients/patients> of your death, we will then do so.  In addition, the Personal Representative may be contacted in the future if TheraClosure is notified of any legal matters pertaining to your practice.  Please be sure that you have discussed these roles with your personal and alternate representatives and have confirmed that they accept the roles.  Note that, once the Practice Executor Agreement is signed, TheraClosure will email your personal and alternative representatives to introduce ourselves and ensure they have our emergency contact information.