Living Will Template
Living Will
12 sections · 23 fields to fill · free, nothing uploaded
LIVING WILL / ADVANCE HEALTHCARE DIRECTIVE
This Living Will is made by:
Name:
Address:
Date of Birth:
DECLARATION
I, , being of sound mind, willingly and voluntarily make this Living Will to declare my wishes regarding medical treatment in circumstances where I am unable to make or communicate my own healthcare decisions.
1. STATEMENT OF INTENT
This document expresses my wishes regarding medical treatment that prolongs my life when I am in:
- Terminal condition
- Permanently unconscious state
- End-stage medical condition
2. HEALTHCARE AGENT
I appoint of , Phone: , as my healthcare agent to make medical decisions on my behalf when I am unable to do so.
Alternate Agent: If my primary agent is unable or unwilling to serve, I appoint of , Phone: .
Agent Authority:
My agent is authorized to:
- Make all healthcare decisions for me
- Access my medical records
- Consent to or refuse treatment
- Choose healthcare providers
- Make decisions about life-sustaining treatment
3. LIFE-SUSTAINING TREATMENT
If I am in a terminal condition or permanently unconscious state:
I Direct That (choose one or more):
- Life-sustaining treatment should be withheld or withdrawn
- Life-sustaining treatment should be provided
- My healthcare agent should decide
Life-Sustaining Treatment Includes:
- Mechanical ventilation
- Cardiopulmonary resuscitation (CPR)
- Artificial nutrition and hydration
- Dialysis
- Antibiotics for life-threatening infections
4. SPECIFIC INSTRUCTIONS
Artificial Nutrition and Hydration:
- I want artificial nutrition and hydration
- I do not want artificial nutrition and hydration
- Leave decision to my healthcare agent
Pain Management:
- I want maximum pain relief even if it hastens death
- I want comfort care measures
Organ Donation:
- I wish to donate my organs and tissues
- I do not wish to donate
- Specific organs only:
Body Disposition:
- Burial
- Cremation
- Donation to medical science
- Other:
5. SPECIAL PROVISIONS
Pregnancy (if applicable):
Religious or Personal Beliefs:
Specific Treatments to Avoid:
Specific Treatments to Receive:
6. QUALITY OF LIFE
My definition of acceptable quality of life:
7. GENERAL STATEMENT
- I want my wishes as stated in this document to be honored
- If there is uncertainty about my wishes, err on the side of
- My healthcare agent should make decisions consistent with my values and beliefs
8. PRIMARY PHYSICIAN
Name:
Specialty:
Phone:
Address:
9. FAMILY NOTIFICATION
Please notify the following people of my condition:
Name: , Relationship: , Phone:
Name: , Relationship: , Phone:
10. REVOCATION
I understand that:
- I may revoke this Living Will at any time
- This Living Will remains in effect until revoked
- A new Living Will supersedes previous versions
11. LEGAL STATEMENT
I understand the full importance of this document and am emotionally and mentally competent to make this Living Will. I make this directive voluntarily and without coercion.
DECLARANT SIGNATURE:
I declare that I am of sound mind and make this Living Will voluntarily.
Signature: _______________________
Name:
Date: _______________________
WITNESS STATEMENTS:
We declare that the person signing this Living Will:
- Appears to be of sound mind
- Signed voluntarily
- Is personally known to us or has provided proof of identity
Witness 1:
Signature: _______________________
Name:
Address:
Date: _______________________
Witness 2:
Signature: _______________________
Name:
Address:
Date: _______________________
HEALTHCARE AGENT ACCEPTANCE:
I accept the role of healthcare agent and agree to make decisions according to the wishes expressed in this document.
Signature: _______________________
Name:
Date: _______________________
NOTARIZATION:
COPIES:
Copies of this Living Will should be given to:
- Healthcare agent
- Alternate agent
- Primary physician
- Healthcare facility
- Close family members
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What is a Living Will?
A Living Will is a personal and family document used when a family arrangement, an authority to act, or a wish about health or property needs to be recorded formally. In short: healthcare directive.
It is typically signed by families, carers, parents, executors and anyone planning ahead or traveling. These documents are the most execution-sensitive in the library. Wills, powers of attorney and affidavits typically require specific formalities — witnesses who are not beneficiaries, notarization, particular wording — and a document that fails on formality fails entirely, however clear its intent.
When you need one
- You are about to healthcare directive and want the terms recorded before anyone relies on them.
- The other side has proposed a living will and you want to see what a balanced version looks like first.
- A previous arrangement was verbal, and something has now happened that makes writing it down urgent.
- You need a starting point you can adapt rather than a blank page — the structure matters more than the prose.
What this Living Will template includes
The template is structured around 12 sections. Each one exists for a reason — if you delete one, delete it deliberately.
- 01Declaration
- 02Statement Of Intent
- 03Healthcare Agent
- 04Life-Sustaining Treatment
- 05Specific Instructions
- 06Special Provisions
- 07Quality Of Life
- 08General Statement
- 09Primary Physician
- 10Family Notification
- 11Revocation
- 12Legal Statement
Information you will need
Gather these before you start. Every one of them appears in the finished document, and a missing value is the most common reason a self-drafted living will fails to do its job.
- Principal Name
- Your name
- Healthcare Agent
- Person to make decisions
- Medical Directives
- Your healthcare wishes
How to write a Living Will
- 1
Read the full template
Read the complete Living Will on this page before you use it, so you know what every clause commits you to.
- 2
Gather your details
Collect the names, addresses, dates and amounts listed in the "What you will need" section — every square-bracketed placeholder needs a real value.
- 3
Fill in the blanks on this page
Type your answers into the form beside the template and they are written into every clause that uses them as you go. Nothing is uploaded — the document is assembled inside your own browser.
- 4
Download the finished document
Download your completed Living Will as a PDF or an editable Word file, or copy the text. There is no signup and no watermark.
- 5
Sign and store it
Sign it — electronically with the free Sign PDF tool, or in ink where the document type requires it — and give every party a copy.
Mistakes to avoid
Getting execution wrong
Wrong number of witnesses, a witness who inherits, missing notarization: any one of these can void the whole document.
Never updating it
Marriage, divorce, births and deaths change what a will or POA should say — and in some jurisdictions marriage revokes an existing will automatically.
Naming one person with no backup
Always name a substitute executor, attorney or guardian. The first choice may be unavailable when it matters.
Nobody can find it
Tell the people who will need it where the original is kept. An unfound will is functionally no will.
Jurisdiction note. Wills, powers of attorney, custody arrangements and advance directives are governed by strict local formalities, and courts apply them literally. Have anything in this category reviewed by a licensed attorney or notary in your jurisdiction before you sign it. This template is general-purpose information, not legal advice.
Living Will FAQs
Is this Living Will template free to download?
Yes. The complete text is published on this page — no email required. Fill in the blanks on the page, then copy it or download it as a PDF, Word (.docx) or plain-text file. There is no watermark and no usage limit.
Can I fill in this Living Will template online?
Yes. Every square-bracketed blank in the template above is an editable field. Type your answer once and it is written into every clause that uses it, and the document beside the form updates as you type. When you are done, download the completed PDF or Word file. It all runs inside your browser — the document is never uploaded, and your answers are saved only in this browser so you can come back and finish later.
What information do I need to complete a Living Will?
At minimum: principal name, healthcare agent, medical directives. The form on this page lists every blank the document contains and counts how many are still empty. Every placeholder in [square brackets] needs replacing before the document is signed — an unfilled bracket is the most common defect in a self-drafted document.
What should a Living Will include?
This template is structured around 12 sections: declaration, statement of intent, healthcare agent, life-sustaining treatment, specific instructions and others. Those are the provisions that make the document do its job; anything you delete, delete deliberately.
Is a Living Will legally binding?
These documents are the most execution-sensitive in the library. Wills, powers of attorney and affidavits typically require specific formalities — witnesses who are not beneficiaries, notarization, particular wording — and a document that fails on formality fails entirely, however clear its intent. Wills, powers of attorney, custody arrangements and advance directives are governed by strict local formalities, and courts apply them literally. Have anything in this category reviewed by a licensed attorney or notary in your jurisdiction before you sign it.
Can I edit this Living Will template?
Yes, in three ways. Fill in the blanks on this page and download the result; or download the Word version and rewrite it in Word, Pages or Google Docs; or open it in the LegalDraft AI app, where the AI can rewrite any individual clause to be stricter, simpler or more balanced and review the finished document for risk before you sign.
Do I need a lawyer for a Living Will?
Wills, powers of attorney, custody arrangements and advance directives are governed by strict local formalities, and courts apply them literally. Have anything in this category reviewed by a licensed attorney or notary in your jurisdiction before you sign it. For routine, low-value arrangements a carefully completed template is usually proportionate. The larger the sum, the more one-sided the terms, or the more the document depends on local statute, the stronger the case for professional review.
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