Florida Living Will
This Living Will is created in accordance with Florida law, specifically under Chapter 765 of the Florida Statutes, which governs advance directives.
Principal Information:
- Name: __________________________
- Address: ________________________
- City, State, Zip: ________________
- Date of Birth: ___________________
Declaration:
I, the undersigned, being of sound mind, voluntarily make this declaration regarding my medical treatment in the event that I become unable to make my own healthcare decisions.
Instructions:
- If I have a terminal condition, I do not want life-prolonging procedures that would only serve to prolong the dying process.
- If I am in a persistent vegetative state, I do not wish to receive life-prolonging procedures.
- In all other circumstances, I wish to receive treatment to maintain my comfort and dignity.
Appointment of Health Care Surrogate:
If I am unable to make my own healthcare decisions, I appoint the following individual as my health care surrogate:
- Name: __________________________
- Address: ________________________
- Phone Number: ___________________
This Living Will reflects my wishes regarding medical treatment and should be honored by all healthcare providers. I understand that I may revoke this document at any time while I am still competent.
Signature: __________________________
Date: _____________________________
Witnesses:
- Witness 1 Name: ___________________
- Witness 1 Signature: _______________
- Date: _____________________________
- Witness 2 Name: ___________________
- Witness 2 Signature: _______________
- Date: _____________________________
This document must be signed in the presence of two witnesses who are not related to me by blood or marriage, and who will not benefit from my estate.