California Living Will Template
This Living Will is created in accordance with California state laws regarding advance health care directives. It allows you to express your wishes regarding medical treatment in the event that you are unable to communicate your preferences.
Personal Information
- Name: _______________________________
- Date of Birth: ________________________
- Address: _____________________________
- City: _________________________________
- State: _______________________________
- Zip Code: ____________________________
Declaration
I, the undersigned, hereby declare that if I become unable to make my own medical decisions, I wish to provide guidance regarding my healthcare. I understand that this document will serve as my Living Will.
My Wishes Regarding Medical Treatment
If I am diagnosed with a terminal illness or am in a state of permanent unconsciousness, I request the following:
- Do not resuscitate me.
- Do not provide artificial nutrition or hydration.
- Provide comfort care to ease my pain.
If I am unable to communicate but not in a terminal condition, I wish to receive the following treatments:
- All treatments that may improve my condition.
- Medications to manage pain and discomfort.
Signature
By signing below, I confirm that I understand the contents of this Living Will and that it reflects my wishes regarding medical treatment.
Signature: ____________________________
Date: _________________________________
Witnesses
This document must be witnessed by two individuals who are not related to me and who are not entitled to any part of my estate.
- Witness 1 Name: __________________________
- Witness 1 Signature: ______________________
- Date: ____________________________________
- Witness 2 Name: __________________________
- Witness 2 Signature: ______________________
- Date: ____________________________________
Thank you for taking the time to complete this important document. Your wishes regarding medical treatment are now clearly stated.