Florida Living Will
This Living Will is made in accordance with Florida law regarding advance directives. It expresses my wishes regarding medical treatment in the event that I become unable to communicate my wishes.
Personal Information:
- Name: ______________________________________
- Address: ____________________________________
- City, State, Zip Code: _______________________
- Phone Number: _______________________________
- Date of Birth: _______________________________
Declaration:
In the event that I am diagnosed as having a terminal condition or am in a persistent vegetative state, I declare my wishes regarding medical treatment as follows:
- I do not want life-prolonging procedures that would only prolong the dying process.
- I want to receive comfort care, which may include pain relief, to improve my quality of life.
- I would like to be surrounded by family and friends during my final moments.
Appointment of Health Care Surrogate:
If I am unable to make health care decisions for myself, I appoint the following person as my health care surrogate:
- Name: ______________________________________
- Address: ____________________________________
- Phone Number: _______________________________
Signature:
By signing below, I affirm that I am of sound mind and am making this declaration voluntarily.
Signature: _________________________________
Date: _____________________________________
This Living Will must be witnessed by at least two individuals who are not related to you by blood or marriage and who will not benefit from your estate.
Witnesses:
- Witness 1: _______________________________ Signature: _______________________________
- Witness 2: _______________________________ Signature: _______________________________
Notarization (optional):
State of Florida, County of ___________________
Subscribed and sworn before me this ____ day of ____________, 20__.
Notary Public: ________________________________
My Commission Expires: ________________________