Living Will Template
This Living Will is designed to comply with the laws of [State Name]. It expresses your wishes regarding medical treatment in the event that you become unable to communicate those wishes yourself.
Please fill in the blanks with your personal information to complete this document.
Personal Information:
- Full Name: ________________
- Date of Birth: ________________
- Address: ________________
- City, State, ZIP Code: ________________
- Phone Number: ________________
Declarations: I, [Your Full Name], being of sound mind, willfully and voluntarily make this declaration. In the event that I am unable to make decisions for myself regarding medical treatment, I wish to make the following statements about my preferences:
- If I am diagnosed with a terminal condition, and my condition is irreversible, I do not want life-sustaining treatment that would only prolong the process of dying.
- If I enter a persistent vegetative state with no reasonable chance of recovery, I do not want life-sustaining treatment.
- If there is any chance for recovery, I want treatment to maintain my comfort and dignity.
I understand that these decisions reflect my personal values and beliefs about medical treatment. This Living Will expresses my medical preferences and will be honored by my family and healthcare providers.
Signature: _____________________
Date: _____________________
Witnesses:
- Witness 1 Name: ________________
- Witness 1 Signature: ________________
- Witness 1 Date: ________________
- Witness 2 Name: ________________
- Witness 2 Signature: ________________
- Witness 2 Date: ________________
This form must be completed according to the laws of [State Name] to ensure its validity. Please consider consulting with a legal professional to ensure that it meets all necessary requirements.