Georgia Living Will Template
This Living Will is created in accordance with Georgia law and is intended to express your wishes regarding medical treatment in the event that you are unable to communicate them yourself.
Principal Information:
- Full Name: ________________________________
- Address: __________________________________
- City, State, ZIP: _________________________
- Date of Birth: ____________________________
Designation of Healthcare Agent:
If you wish, you may also designate a healthcare agent who will have the authority to make healthcare decisions on your behalf. If not, this document stands alone.
- Agent's Full Name: __________________________
- Agent's Address: _____________________________
- Agent's Phone Number: ______________________
Declaration:
I, the undersigned, hereby declare that if I am diagnosed with a terminal illness or an irreversible condition:
- I wish for my healthcare providers to forego life-sustaining treatment if such treatment would only prolong the dying process.
- I do not wish to receive treatment that would keep me alive artificially in a state I consider unbearable.
- My preferences shall always be considered above any standard treatment protocols.
Signature:
By signing below, I confirm that I am at least 18 years old and am of sound mind. This Living Will reflects my personal wishes and has been created voluntarily.
Signature: ___________________________
Date: ________________________________
Witnesses:
This document must be signed in the presence of two witnesses. The witnesses should not be related to you, entitled to any portion of your estate, or your healthcare agent.
- Witness Name: ___________________________ Signature: ___________________________ Date: ____________
- Witness Name: ___________________________ Signature: ___________________________ Date: ____________
Notary Public:
Consider having this document notarized to further ensure its validity.
State of Georgia
County of ____________________________
Subscribed and sworn to before me on this __ day of __________, 20__.
Notary Public Signature: ___________________________
My Commission Expires: ___________________________