Texas Living Will
This document serves as your Living Will under Texas law. It outlines your wishes regarding medical treatment in situations where you may be unable to communicate your preferences.
Important Notice: A Living Will can help guide your loved ones and healthcare providers in making decisions that align with your wishes, especially during critical times.
Please fill out the information below to create your Living Will:
- Full Name: ____________________________
- Date of Birth: ________________________
- Address: ______________________________
- City: _________________________________
- State: Texas
- Zip Code: ____________________________
- Phone Number: ________________________
In the event that I am diagnosed with a terminal illness or am in a state of irreversible coma, I direct that my healthcare providers honor the following wishes:
- I do not wish to receive life-sustaining treatment if I am unable to communicate my wishes.
- I wish to receive comfort measures to alleviate pain, even if they may hasten my death.
- If I am in a persistent vegetative state, I do not want any extraordinary measures taken to prolong my life.
If you have designated an agent to make healthcare decisions on your behalf, please provide their information below:
- Agent's Full Name: ____________________________
- Agent's Date of Birth: ________________________
- Agent's Address: ______________________________
- Agent's Phone Number: ________________________
Please ensure that this document is signed in the presence of two witnesses who are not related to you and who do not stand to inherit from you.
Sign Here: ____________________________ Date: ________________
Witness #1 Signature: __________________ Date: ________________
Witness #2 Signature: __________________ Date: ________________
Keep this Living Will in a safe place and share copies with your loved ones and healthcare providers to ensure your wishes are respected.