Georgia Living Will
This Living Will is created in accordance with Georgia law and expresses my wishes regarding medical treatment in the event I become unable to make my own healthcare decisions.
Personal Information
- Name: ______________________________
- Date of Birth: ________________________
- Address: ______________________________
- Phone Number: ________________________
Declaration
I, the undersigned, declare that if I become unable to make my own medical decisions, I do not wish for my life to be prolonged by any of the following measures:
- Artificial respiration.
- Cardiac resuscitation.
- Dialysis.
- Nutritional support through feeding tubes.
In the absence of my ability to communicate, I wish for the following individuals to make healthcare decisions on my behalf:
- Name of Healthcare Proxy: _____________________________
- Relationship: ______________________________________
- Phone Number: ______________________________________
Signatures
By signing below, I confirm that I have read and understand this document. I am of sound mind and voluntarily execute this Living Will.
Signature: ___________________________ Date: _______________
Witness Signature: ____________________ Date: _______________
Witness Signature: ____________________ Date: _______________