Florida Living Will Template
This Living Will is created in accordance with Florida Statutes Section 765.303, which allows individuals to document their wishes regarding medical treatment in the event they are unable to communicate these wishes themselves.
Principal Information:
- Name: _______________________________
- Address: _______________________________
- City, State, Zip Code: _______________________________
- Date of Birth: _______________________________
Declaration:
I, the undersigned, being of sound mind, willfully and voluntarily make this declaration to express my wishes regarding medical treatment, in case I become terminally ill or permanently unconscious.
Medical Treatment Preferences:
- If I am diagnosed with a terminal condition, I do not want life-sustaining treatment to be provided.
- If I am diagnosed as being in a persistent vegetative state, I do not want life-sustaining treatment to be provided.
- If I am diagnosed with a chronic illness that leads to irreversible decline, I prefer to receive comfort care only.
- I wish to receive palliative care for pain relief and comfort at all times.
Additional Instructions:
______________________________________________________________________
______________________________________________________________________
This Living Will is signed and dated as follows:
- Signature: _______________________________
- Date: _______________________________
Witnesses:
Two witnesses must sign this document to validate it. Witnesses cannot be related to the declarant by blood or marriage, nor can they be entitled to any part of the declarant's estate.
- Witness 1 Name: _______________________________
- Witness 1 Signature: _______________________________
- Date: _______________________________
- Witness 2 Name: _______________________________
- Witness 2 Signature: _______________________________
- Date: _______________________________
This document expresses my wishes concerning medical treatment and may be revoked at any time by my writing or by a verbal statement made in the presence of a witness.