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If you receive more than one proxy form, please complete, date, sign and return each one. Discuss your health care wishes and this form with your agent.Attached is a health care proxy form that you can complete for your records. How to complete the proxy form. Insert the creditor's full address (including postcode). Name of Proxy Holder. The following instructions are based on a sample proxy form. The file is in PDF format and can be opened with the free Adobe Reader. Proxy forms may also be filed on site at the. Step 2: The EBoard member and the Proxy MUST complete the proxy form.