California Living Will Template
This Living Will is created in accordance with the laws of the State of California. It provides directions for medical treatment if you become unable to communicate your wishes.
Declarant's Information:
- Full Name: ________________________________
- Date of Birth: ________________________________
- Address: ________________________________
- City, State, Zip Code: ________________________________
Instructions:
If at any time I am unable to understand or make decisions regarding my medical treatment, I wish to convey the following directives:
- I do not wish to receive life-sustaining treatments that would only prolong the dying process.
- I prefer to receive comfort care to keep me comfortable in my final days.
- If I am diagnosed with a terminal illness or condition, I wish to forego aggressive treatments.
- I request that the medical staff involved in my care respect my wishes as stated in this document.
Designation of Healthcare Proxy:
I designate the following individual as my healthcare agent:
- Agent's Full Name: ________________________________
- Relationship to Declarant: ________________________________
- Contact Number: ________________________________
Signatures:
This Living Will must be signed and dated below:
Declarant's Signature: ________________________________
Signature Date: ________________________________
Witness Information:
- Witness 1 Name: ________________________________
- Witness 1 Signature: ________________________________
- Witness 2 Name: ________________________________
- Witness 2 Signature: ________________________________
It is highly advisable to consult with an attorney or healthcare professional for any modifications or specific needs regarding this Living Will.