Arizona Living Will Template
This Living Will is created in accordance with Arizona state laws regarding advance directives. It outlines your wishes regarding medical treatment in the event that you become unable to communicate your preferences.
Personal Information:
- Name: ____________________________
- Date of Birth: ______________________
- Address: ___________________________
- City, State, Zip: ____________________
Declaration:
I, the undersigned, being of sound mind, willfully and voluntarily make this declaration regarding my health care. If I am diagnosed with a terminal condition, or if I am in a persistent vegetative state, I direct that my health care providers follow my wishes as stated below:
My Wishes:
- If I am unable to communicate, I do not wish to receive life-sustaining treatment if:
- My condition is terminal, and I am expected to die within six months; or
- I am in a persistent vegetative state.
- I wish to receive comfort care to alleviate pain and suffering.
- I do not wish to be kept alive by artificial means, including but not limited to:
- Mechanical ventilation;
- Cardiopulmonary resuscitation (CPR);
- Feeding tubes;
- Dialysis.
Signature:
______________________________
Date: ________________________
Witnesses:
This document must be signed in the presence of two witnesses who are not related to you and who will not inherit from you.
- Witness 1 Name: _______________________ Signature: ______________________
- Witness 2 Name: _______________________ Signature: ______________________
This Living Will is effective immediately upon signing and revokes any prior Living Wills.