Florida Living Will Template
This Living Will is created in accordance with Florida law, specifically Chapter 765 of the Florida Statutes. It allows you to express your wishes regarding medical treatment in case you become unable to communicate those wishes yourself.
Personal Information
Name: ___________________________
Address: _________________________
City: ____________________________
State: _____________ Zip Code: _____________
Date of Birth: ______________________
Instructions
- Under what circumstances do you wish to cease life-sustaining treatment? Describe any specific conditions or illnesses.
- Do you want comfort care measures to be administered? Yes / No
- Specify any particular procedures or treatments you do or do not want:
Durable Power of Attorney for Health Care
If there is someone you trust to make medical decisions on your behalf, please provide their information below:
Name: ___________________________
Address: _________________________
Phone Number: ____________________
Witnesses
This Living Will must be signed in the presence of two witnesses who are not related to you or entitled to any portion of your estate. Below, provide their details:
- Witness 1:
Name: _________________________
Address: _______________________
Signature: ____________________________
- Witness 2:
Name: _________________________
Address: _______________________
Signature: ____________________________
Signature
By signing below, I confirm that I understand the contents of this Living Will and I am doing so voluntarily:
Signature: ___________________________
Date: _______________________________