Georgia Living Will
This Living Will is made in accordance with the laws of the State of Georgia. In this document, I express my wishes regarding the medical treatment I wish to receive or not receive in the event that I am unable to communicate my preferences.
Personal Information
- Full Name: ______________________________
- Date of Birth: ______________________________
- Address: ______________________________
- City, State, Zip Code: ______________________________
- Phone Number: ______________________________
- Email Address: ______________________________
Statement of Intent
If I am determined to be in a terminal condition, or if I am persistently unconscious, I direct my healthcare providers to withhold or withdraw life-sustaining procedures according to my wishes stated herein.
Medical Preferences
- Accept any medical treatment intended to alleviate suffering, even if it may hasten my death.
- Refuse resuscitation or any other means of prolonging my life.
- Specify certain medical treatments I do not wish to receive: ___________.
- Detail any specific types of care or procedures I desire: ___________.
Designated Healthcare Agent
I designate the following individual as my healthcare agent to make decisions on my behalf should I be unable to do so:
- Name: ______________________________
- Relationship: ______________________________
- Contact Information: ______________________________
This Living Will reflects my desires regarding medical treatment. I understand this document serves to convey my treatment preferences in circumstances where I cannot communicate them myself. I affirm that I am of sound mind and that I willingly execute this Living Will.
Signature: ______________________________
Date: ______________________________
Witnesses:
- Witness 1: ______________________________ (Signature) ____________ (Date)
- Witness 2: ______________________________ (Signature) ____________ (Date)
Note: It is recommended to review this document with a qualified attorney to ensure it meets all legal requirements.