Georgia Living Will Template
This Living Will is designed to comply with the laws of the state of Georgia. It allows you to outline your medical treatment preferences in case you become unable to communicate your wishes.
By filling out this document, you express your desires regarding life-sustaining treatment in a clear and legal manner.
Personal Information
- Name: ________________________________
- Date of Birth: ________________________
- Address: _____________________________
- City: ________________________________
- State: Georgia
- ZIP Code: ____________________________
Declaration
I, the undersigned, hereby declare that if I become terminally ill or permanently unconscious, I do not wish for my life to be prolonged by any technological means if such measures only delay the moment of my death.
Treatment Preferences
In accordance with my preferences, I make the following choices regarding my medical treatment:
- Life-Sustaining Treatment: I do not want life-sustaining treatment, such as mechanical ventilation or resuscitation.
- Nutrition and Hydration: I do not want nutrition and hydration provided artificially.
- Pain Relief: I wish to receive medication for pain relief even if it hastens my death.
Signature
By signing below, I affirm that I have read and understood this Living Will. This declaration reflects my wishes and has been made voluntarily.
Signature: _______________________________
Date: ___________________________________
Witnesses
Two witnesses are required for this Living Will. The following individuals may not be related to you or entitled to any portion of your estate:
- Witness 1: _____________________________
- Signature: ____________________________
- Date: _________________________________
- Witness 2: _____________________________
- Signature: ____________________________
- Date: _________________________________
This form is effective immediately upon signing and remains in force unless revoked in writing.