California Living Will Template
This Living Will is made in accordance with the California Probate Code Section 4670 et seq. It outlines your wishes regarding medical treatment in the event that you become unable to communicate your preferences.
Personal Information
- Full Name: _______________________________
- Date of Birth: __________________________
- Address: ________________________________
- City, State, Zip Code: _________________
Declaration
I, the undersigned, being of sound mind, voluntarily make this declaration regarding my medical treatment. If I am diagnosed with a terminal illness, or if I am in a persistent vegetative state, I wish to express my preferences as follows:
- Life-Sustaining Treatment:
- Do you wish to receive life-sustaining treatment? (Yes/No) ____________
- Artificial Nutrition and Hydration:
- Do you wish to receive artificial nutrition and hydration? (Yes/No) ____________
- Other Specific Wishes:
- __________________________________________________________
- __________________________________________________________
Designation of Health Care Agent
If I am unable to make medical decisions for myself, I designate the following individual as my health care agent:
- Name: _______________________________
- Relationship: ________________________
- Phone Number: ______________________
Signature
By signing below, I confirm that I am making this Living Will voluntarily and that I understand its contents.
Signature: _______________________________
Date: _________________________________
This document should be kept in a safe place and shared with family members and your health care agent. It is advisable to review your Living Will periodically to ensure it reflects your current wishes.