Florida Living Will
This Living Will is executed in accordance with Florida law, specifically Section 765.302 of the Florida Statutes. It expresses your wishes concerning medical treatment in case you are terminally ill or in a persistent vegetative state.
Instructions: Please complete the information below to create your Living Will.
- Full Name: _________________________________________
- Address: _________________________________________
- City, State, Zip Code: ___________________________
- Date of Birth: ______________________________________
- Emergency Contact Name: _________________________
- Emergency Contact Phone Number: ________________
Declaration: I, the undersigned, hereby declare that if I become unable to make my own healthcare decisions due to a terminal illness or persistent vegetative state, I direct that:
- 1. I do not wish to receive any form of life-sustaining treatment, including but not limited to:
- Feeding tubes
- Mechanical ventilation
- Cardiopulmonary resuscitation (CPR)
- 2. I wish to receive comfort care, including pain relief, when needed.
- 3. If possible, I wish to die in a place of my choosing surrounded by my loved ones.
Signatures:
By signing this document, I affirm that I understand its content and the implications of my choices.
Signature: _________________________________________
Date: _____________________________________________
Witnesses:
We, the undersigned, declare that the person who signed this Living Will is known to us and appears to be of sound mind and free of duress.
- Witness 1 Name: ________________________________
- Witness 1 Signature: ___________________________
- Witness 1 Date: ________________________________
- Witness 2 Name: ________________________________
- Witness 2 Signature: ___________________________
- Witness 2 Date: ________________________________