The Emergency Room Form

The Emergency Room Form provides helpful information to healthcare professionals that normally would take some time to uncover. The Emergency Room Form is also known as a Health Care Proxy Form because it acts as your agent in case you are unable to communicate your care. Keep this form in the front pocket of your health manager, it serves healthcare professionals as an accurate directive or snapshot to your individual beliefs, demands and socioeconomic standing.


Heaven forbid that you would be in an emergency that would leave you unable to communicate. The Patient Better Emergency Room Form is an in-depth detailer to always keep in the Patient Better Health Manager. Make this template available to any health professional that you may encounter to secure important information that needs to be communicated quickly.

By the way, for various reasons, people with pre-existing health conditions are three times more likely to wind up in the emergency room.


  • Always keep this form within reach or inside your Patient Better Health Manager.

  • Complete the Emergency Room form to its entirety.

  • Update annually or after a visit to the emergency room

Click Here to Download YOUR EMERGENCY FORM

When should I go to the emergency room?