Florida Living Will
This Florida Living Will is a legal document that expresses your wishes regarding medical treatment in the event that you become unable to communicate those wishes yourself. This document is created in accordance with Florida Statutes, Chapter 765.
Instructions: Fill in the blanks with your personal information and make sure your document is properly signed and witnessed as required by Florida law.
PERSONAL INFORMATION:
- Name: _____________________________
- Address: _____________________________
- Date of Birth: _____________________________
DECLARATION:
I, the undersigned, hereby declare this Living Will as my directive concerning the medical treatment I desire. If I am diagnosed with a terminal condition or if I am in a persistent vegetative state, I request the following:
- To withhold or withdraw life-prolonging procedures, including but not limited to the following:
- Artificial nutrition and hydration
- Respiratory support
- Cardiac resuscitation
- I wish to receive comfort care and pain relief.
ADDITIONAL WISHES:
Additional instructions, if any: _____________________________________________
___________________________________________________________________________
OPENING STATEMENT:
I understand that this Living Will must be signed in the presence of two witnesses or a notary public. Witnesses cannot be family members or individuals entitled to any part of my estate.
WITNESS STATEMENT:
- Signature of Witness 1: _____________________________
- Name of Witness 1: _____________________________
- Address of Witness 1: _____________________________
- Signature of Witness 2: _____________________________
- Name of Witness 2: _____________________________
- Address of Witness 2: _____________________________
DATE OF SIGNING: _____________________________
This Living Will is executed in accordance with Florida law and becomes effective immediately upon signing.