Georgia Living Will Template
This Living Will is created in accordance with the laws of the State of Georgia. It is designed to express your wishes regarding medical treatment in the event that you become unable to communicate your preferences.
Personal Information:
- Full Name: _______________________________
- Date of Birth: __________________________
- Address: ________________________________
- City, State, Zip Code: __________________
- Phone Number: _________________________
Declaration:
I, _______________________________, being of sound mind, voluntarily make this declaration to provide guidance regarding my healthcare decisions in the event that I am unable to communicate my wishes.
Medical Treatment Preferences:
If I become terminally ill or permanently unconscious, I do not wish for my life to be prolonged by any of the following means:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Artificial nutrition and hydration
- Other life-sustaining treatments: __________________________
Appointment of Healthcare Agent:
I hereby appoint the following individual as my healthcare agent to make decisions on my behalf if I am unable to do so:
- Name: _______________________________
- Relationship: ________________________
- Address: ____________________________
- Phone Number: _______________________
Witnesses:
This declaration must be signed in the presence of two witnesses who are not related to me by blood or marriage, and who are not entitled to any portion of my estate.
- Witness 1: ___________________________
- Witness 2: ___________________________
Signature:
By signing below, I affirm that I am of sound mind and that this document reflects my wishes regarding medical treatment.
Signature: _______________________________
Date: _______________________________