Florida Living Will
This Florida Living Will template is designed in accordance with Florida statutes regarding advance directives and end-of-life decisions. By completing this document, you can express your wishes about medical treatment in case you are unable to communicate them yourself.
Please fill in the blanks with your information as needed:
1. Declarant Information:
- Name: ________________________________
- Date of Birth: _________________________
- Address: ______________________________
- City, State, Zip: ______________________
2. Designation of Health Care Surrogate: (This is the person you choose to make health care decisions on your behalf.)
- Name of Surrogate: _______________________
- Address: ________________________________
- Phone Number: ___________________________
3. Living Will Declaration:
If I am diagnosed with a terminal condition or a condition that results in permanent unconsciousness, I direct that:
- Life-sustaining treatment be withheld or withdrawn in accordance with my wishes as stated below.
- I do not wish to receive treatments that prolong the dying process.
- I would like to receive comfort care that alleviates suffering.
4. Additional Instructions: (You may specify any additional wishes regarding your health care or treatments.)
__________________________________________________________
__________________________________________________________
5. Signatures:
By signing below, I confirm that I am of sound mind and voluntarily creating this Living Will.
Signature of Declarant: _______________________ Date: _______________
Signature of Witness 1: _______________________ Date: _______________
Signature of Witness 2: _______________________ Date: _______________
6. Notarization (Optional):
The foregoing instrument was acknowledged before me this ___ day of ____________, 20__.
Notary Public Signature: _______________________ My Commission Expires: _______________