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 you become unable to communicate your preferences.
Personal Information
- Name: _______________________________
- Date of Birth: ________________________
- Address: _____________________________
- City: _________________________________
- State: Arizona
- Zip Code: ____________________________
Declaration
I, the undersigned, being of sound mind, voluntarily make this declaration to be followed in the event that I become unable to communicate my wishes regarding medical treatment.
Healthcare Preferences
- If I am diagnosed with a terminal condition, I do not wish to receive life-sustaining treatment.
- If I am in a persistent vegetative state, I do not wish to receive life-sustaining treatment.
- If I am diagnosed with a condition that will lead to my death within a short period, I wish to receive comfort care only.
Appointment of Healthcare Representative
I appoint the following individual as my healthcare representative:
- Name: _______________________________
- Phone Number: ________________________
- Address: _____________________________
This representative is authorized to make healthcare decisions on my behalf, in accordance with my wishes as outlined in this Living Will.
Signatures
By signing below, I affirm that I understand the contents of this Living Will and that I am signing it voluntarily.
Signature: _______________________________
Date: ___________________________________
Witnesses
Two witnesses must sign below, attesting that the principal is of sound mind and under no undue influence.
- Witness 1 Name: ______________________
- Witness 1 Signature: __________________
- Date: ________________________________
- Witness 2 Name: ______________________
- Witness 2 Signature: __________________
- Date: ________________________________
This Living Will is effective immediately upon signing, unless otherwise specified.