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Living Will
Who is completing this document?
*
Indicates required field
Name
*
First
Last
City
*
County
*
Sate
*
Birthday (Month/Day/Year)
*
What kind of health care directives do you want to give?
*
Directives about end-of-life treatment (Living Will)
Designation of another person to make health care decisions for your (Health Care Power of Attorney)
Both (Advance Directive)
Select the appropriate option. Depending on your selection, you will either create a Living Will, Health Care Power of Attorney, or a document that combines features of both, sometimes referred to as an Advance Directive. The document's title will depend on your selection and your state's law.
If you have a terminal condition and are expected to die within six months, should life-sustaining treatment be withheld and withdrawn?
*
Yes
No
Select "Yes" if you want life-sustaining treatment to be withheld and withdrawn if you have a terminal condition and are expected to die within six months. Otherwise, select "No." CAUTION: YOU MUST INITIAL THE STATEMENTS ABOUT LIFE-SUSTAINING TREATMENT ON THE DOCUMENT.
If you have an irreversible condition, cannot care for yourself or make decisions for yourself, and will die without life-sustaining treatment, should life-sustaining treatment be withheld and withdrawn?
*
Yes
No
Select "Yes" if you want life-sustaining treatment to be withheld and withdrawn if you have an irreversible condition, cannot care for yourself or make decisions for yourself, and will die without life-sustaining treatment. Otherwise, select "No." CAUTION: YOU MUST INITIAL THE STATEMENTS ABOUT LIFE-SUSTAINING TREATMENT ON THE DOCUMENT.
Will a statement regarding artificially provided food and fluids be included?
*
Yes
No
Select "Yes" to include a provision regarding whether artificially administered nutrition and hydration will be provided, even though there is no hope of recovery from your condition.
Do you want to receive artificially provided food and fluids?
*
Yes, I wish to receive
No, I do not wish to receive
Select "Yes" if you WISH TO RECEIVE artificially administered nutrition and hydration, even though there is no hope of recovery from your condition.
What other specific requests or instructions do you wish to make?
*
Enter any other specific requests or instructions.
How will this document be finalized?
*
Signed in front of a Notary Public
Signed in front of 2 witnesses
Signed in front of BOTH a Notary Public and 2 witnesses
In order to be legal this document must either be signed in the presence of two witnesses or a notary public. We recommend you sign the document BOTH in the presence of two witnesses AND a notary public.
Who is the first Witness? (if applicable)
*
You may enter the witness information now or when the document is signed. CAUTION: Carefully review and comply with the limits on who may be a witness that are printed on the document.
Address
*
City
*
State
*
Zip Code
*
Who is the second Witness? (if applicable)
*
Address
*
City
*
State
*
Zip Code
*
Submit
Home
About Us
FOUNDER
>
Brian Blackwell
CORE VALUES
BRAND AMBASSADORS
CAREERS
SERVICES
NEW BUSINESS PACKAGE
CONSULTING
INSURANCE
INVESTING
>
REAL ESTATE INVESTING
REAL ESTATE DEVELOPMENT
RETIREMENT PLANNING
OIL & GAS
LEGAL
MEDIA
SPEAKING ENGAGEMENTS
Contact Us