California Living Will Template
This Living Will is prepared in accordance with California state laws. It allows individuals to outline their preferences for medical treatment and end-of-life care.
Instructions: Fill in the blanks with your personal information as needed.
I, __________________________, a resident of California, born on _____________, hereby declare this Living Will.
1. Designation of Health Care Agent:
If I am unable to make my own healthcare decisions, I designate the following person as my Health Care Agent:
Name: __________________________
Address: __________________________
Phone Number: __________________________
2. Special Instructions:
My wishes regarding medical treatment are as follows:
- If I am terminally ill and unable to communicate my wishes, I wish to receive the following:
- Life-sustaining treatment:
- Cardiopulmonary resuscitation (CPR):
- Artificial nutrition and hydration:
3. Additional Preferences:
Other specific preferences for my care:
____________________________________________________________________
4. Signature:
By signing this document, I affirm that I am of sound mind and that I understand the contents of this Living Will.
Signature: __________________________
Date: _____________
Witnesses:
Two witnesses must sign this document per California law. Fill in witness information below:
- Name: __________________________
- Address: __________________________
- Signature: __________________________
- Name: __________________________
- Address: __________________________
- Signature: __________________________
This document reflects my wishes and must be honored by my healthcare providers.