Florida Living Will
This Living Will is created in accordance with Florida law, specifically referencing the Florida Statutes Chapter 765.
Please fill in the information below to ensure your wishes are documented clearly.
- Declarant's Name: ____________________________________
- Date of Birth: ____________________________________
- Address: ____________________________________
- City, State, Zip Code: ____________________________________
Declaration:
I, the undersigned, being of sound mind, make this declaration regarding my healthcare decisions. If I am unable to make my own medical decisions due to a terminal condition, or if I am in a persistent vegetative state, I direct that:
- Medical Treatments: I do not wish to undergo the following life-sustaining treatments:
- 1. ____________________________________
- 2. ____________________________________
- 3. ____________________________________
- Palliative Care: I wish to receive care that alleviates pain and discomfort.
- Organ Donation: I consent to organ donation under the following circumstances:
- ____________________________________
Witnesses: This Living Will must be signed in the presence of two witnesses. They are not related to me, nor are they entitled to any part of my estate or have any financial interest in my healthcare decisions.
- Witness 1 Name: ____________________________________
- Witness 1 Signature: _______________________________
- Date: ____________________________________
- Witness 2 Name: ____________________________________
- Witness 2 Signature: _______________________________
- Date: ____________________________________
Signature of Declarant: ____________________________________
Date: ____________________________________
This document expresses my wishes regarding healthcare decisions and shall remain in effect until I revoke it in writing.