California Living Will Template
This California Living Will is designed to comply with California state laws regarding advanced healthcare directives.
By completing this document, you can outline your preferences for medical treatment in the event that you become unable to communicate your wishes. This document is meant to provide guidance to your loved ones and healthcare providers.
Personal Information
- Full Name: ___________________________________
- Date of Birth: _______________________________
- Address: ____________________________________
- City, State, Zip Code: ______________________
- Phone Number: ______________________________
Designated Healthcare Agent
You may designate a person to make healthcare decisions on your behalf. This person must be at least 18 years old and cannot be your healthcare provider.
- Full Name of Healthcare Agent: ___________________________________
- Relationship to You: _______________________________
- Phone Number: _____________________________________
Instructions for Medical Treatment
In the event that you are diagnosed with a terminal condition, or if you are in a state of permanent unconsciousness, you may wish to express your desires regarding life-sustaining treatments.
Check the appropriate boxes to indicate your preferences:
If you have specific wishes beyond the above statements, please outline them here:
_____________________________________________________________
_____________________________________________________________
Additional Wishes
Feel free to provide any further instructions or wishes regarding your healthcare:
_____________________________________________________________
_____________________________________________________________
Signatures
This document must be signed by you, the principal, and should also be witnessed. Witnesses cannot be your designated agent or related to you by blood or marriage.
Signature of Principal: ____________________________
Date: ____________________________________________
Witness Signatures
- Signature of Witness 1: ___________________________
- Signature of Witness 2: ___________________________
Date: ____________________________________________
Remember that this Living Will should be stored in a safe place, and your healthcare agent and loved ones should have access to it to ensure that your wishes are honored.