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The best way to enroll in DocuBank is through an estate planning professional. To find a DocuBank Provider in your area, please call us at 866-829-0993.

To enroll on your own: Complete the enrollment form below. Next, print it out and sign it. (Alternatively, you can print the form and then fill it out by hand.)

Send the following materials to DocuBank:

The completed enrollment form (signed).
A signed copy of your Healthcare Directives (Living Will, Healthcare Power of Attorney, organ donation form). Note: We do not require original documents.
Your payment — check for $65 for one year / $150 for three years / $235 for five years; or credit card information).

Mail the enrollment materials to:
DocuBank
PO Box 629
Springfield, PA 19064

A. Personal Information

Email Address

Prefix

First Name

M.I.

Last Name

Suffix

Mailing Address

Address Line 2

City/Municipality

State

Zip Code

Primary Phone Number

Alternate Phone Number

Date of Birth

B. Emergency Contacts: (Optional)

The names and phone numbers of your emergency contacts and physician will be provided to hospital staff when your documents are requested. If your Living Will, Health Care Power of Attorney, or other Healthcare Directives names people to make decisions for you, please list up to three of them here in the same order. If no one is listed in your documents, you may choose up to three people as emergency contacts and list them here.

Contact 1

First Name

Last Name

Home Phone

Work Phone

Ext.

Cell Phone

Email Address

Contact 2

First Name

Last Name

Home Phone

Work Phone

Ext.

Cell Phone

Email Address

Contact 3

First Name

Last Name

Home Phone

Work Phone

Ext.

Cell Phone

Email Address