Skip to content
Feel free to ask any question
support@eformscreator.com
Instant Delivery
24 * 7 Customer support
Login
Business
Balance Sheet Online
Employment Contract Online
Letter of Termination Online
Promissory Note Online
Business Plan Online
Employee Handbook Online
Non-Disclosure Agreement Online
Release of Liability Online
Cease and Desist All Copyright Infringement Online
Invoice Online
Non-Compete Agreement Online
Warranty Deed Online
Consulting Agreement Online
Job Application Form Online
Purchase Order Online
Family & Personal
Affidavit Online
Boat Bill of Sale Online
Letter Of Recommendation Online
Personal Financial Statement Online
Affidavit of Death Online
General Bill Of Sale Online
Last Will and Testament Agreement Online
Power of Attorney Online
Affidavit of Heirship Online
Guardianship Online
Living Will Online
Resignation Letter Online
Birth certificate Online
Letter of Agreement Online
Medical Consent Online
Vehicle bill Of Sale Online
Deeds & Property
Affidavit of Small Estate Online
Eviction Notice Online
Rental Application Online
Triple Net Lease Agreement Online
Article of Incorporation Online
Lease Agreement Online
Residential Lease Agreement
Warranty Deed Online
Commercial Lease Agreement
Month to Month Lease Agreement Online
Real Estate Purchase Online
Contract For Deed Online
Quit Claim Deed Online
Sublease Agreement Online
Tax Form
1099-MISC Online
W3 Online
1099-NEC Online
W4 Online
2553 Form Online
W9 Online
W2 Online
pay stub generator
Contact
Living Will PDF
Living Will
Living Will
Step
1
of
11
9%
Email
*
Already have an account?
Login
Who is the Declarant, the person for whom this living will is being created?
Declarant's Name:
The Declarant is a woman or a man.
Declarant's Gender:
Male
Female
What is the address of the Declarant?
Enter Address:
Enter City:
Enter County:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Declarant Signature
Select
Draw Signature
Upload Signature
Draw Signature
Upload Signature
Drop files here or
Select files
Max. file size: 2 MB, Max. files: 1.
Enter Zip Code:
What is the contact information for the Declarant?
Enter Telephone Number:
Who do you choose as your Advocate to decide on your behalf when it comes to your health care?
Enter Advocate's Name:
PDF Preview
What are the Advocate's mail and phone number?
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
If the primary advocate is unavailable or unwilling to make healthcare choices on your behalf, would you wish to select an Alternate Advocate?
Appoint Alternate Advocate:
Yes
No
What are the Alternate Advocate's name and contact information?
Enter Alternate Advocate's Name:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
Would you like to appoint a second Alternate Advocate?
Appoint Second Alternate Advocate:
Yes
No
Who is the second Alternate Advocate, and what is their information?
Enter Second Alternate Advocate Name:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
Would you prefer to give the Advocate the ability to make choices about your health care as of a certain date or under a certain circumstance?
The Advocate's authority to make health care decisions for you will commence if your physician determines you lack the capacity to make your own decisions or you become incapacitated. Would you like to specify another circumstance?:
Yes
No
Specify Date or State Condition:
Date
Condition
Commencement Date:
DD slash MM slash YYYY
Enter Details:
Will this living have a health care power of attorney linked to it?
Attach Health Care Power of Attorney:
Yes
No
PDF Preview
If you are diagnosed with a terminal illness, would you like to specify in this living will whether you want to receive life-sustaining medical care?
Specify care in case of terminal illness:
Yes
No
Do you wish to receive or not receive life-sustaining medical treatment if diagnosed with a terminal illness?:
Receive
Not receive
If you enter a permanent unconscious or vegetative condition, would you like to specify in this living will whether you want to accept or reject life-sustaining medical care?
Specify vegetative care:
Yes
No
Do you wish to receive or not receive life-sustaining medical treatment if you fall into a permanent unconcious or vegetative state?:
Receive
Not receive
Would you like to specify in this living will whether you want to accept or reject medical treatment that would keep you alive if you become somewhat unconscious but still unable to make decisions?
Specify marginally conscious care:
Yes
No
Do you wish to receive or not receive life-sustaining medical treatment if you go into a marginally unconcious state?:
Receive
Not receive
Would you like to specify in this Living Will whether you want to accept or reject medical care that would keep you alive if you were to be diagnosed with an incurable illness or experience excruciating pain?
Specify care for untreatable condition:
Yes
No
Do you wish receive or not receive life-sustaining medical care if you are diagnosed with an untreatable condition or are in severe pain?:
Receive
Not receive
PDF Preview
Do you want CPR performed on you to extend your life?
Select Option:
Receive
Not receive
Do you want to try to extend your life by using a respirator or ventilator, or do you want to avoid doing so?
Select Option:
Receive
Not receive
Do you want to be fed through a tube to extend your life
Select Option:
Receive
Not receive
Do you want to or do you not want to get blood transfusions to extend your life?
Select Option:
Receive
Not receive
Do you want to undergo invasive diagnostic procedures such as surgery or surgery to extend your life?
Select Option:
Receive
Not receive
PDF Preview
Do you want to try to extend your life by getting renal dialysis or not?
Select Option:
Receive
Not receive
Do you want to be given antibiotics or other treatments to extend your life?
Select Option:
Receive
Not receive
Do you want to take painkillers with the highest potency or not?
Select Option:
Receive
Not receive
Do you want to be given the strongest painkillers possible, even if they could speed up your death?
Select Option:
Receive
Not receive
Do you want to take or not take the strongest painkillers possible, even if they can lead to a brief addiction if you get well or survive your condition?
Select Option:
Receive
Not receive
PDF Preview
Do you want to add any more details on comfort care or life-sustaining treatment?
Additional Instructions?:
Yes
No
What additional directives would you like to include?:
Please check the boxes next to any circumstances in which you wouldn't want to extend your life.
Do not prolong life if:
I have an incurable or irreversible condition
I become permanently unconscious or fall into a vegetative state
Third Choice
If you didn't select any of the above options, would you like to state in your Living Will that you wish to prolong life to the greatest extent possible within accepted health care standards?:
Yes
No
PDF Preview
If you require a Guardian, would you like to designate the person who would be in charge of taking care of your daily needs?
Specify who will be your Guardian:
Yes
No
Would you prefer to name the Advocate in charge of making choices about your medical treatment as your Guardian?
Appoint your Advocate as Guardian?:
Yes
No
Would you like to appoint someone else to act as your Guardian?
Appoint New Guardian:
Yes
No
What is name, address and telephone number of the person you would like to appoint as your Guardian?
Enter Name of Guardian:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
Would you like to include an alternate Guardian?
Appoint Alternate Guardian?:
Yes
No
What is the name, address and telephone number of the the alternate Guardian?
Enter Name of Alternate Guardian:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
Would you like to include a second alternate guardian?
Appoint Second Alternate Guardian?:
Yes
No
What is the name, address and telephone number of the second alternate Guardian?
Enter Name of Second Alternate Guardian:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
PDF Preview
Would you desire to donate any organs once you pass away?
Make anatomical donation?:
Yes
No
I would like to:
Donate entire body
Donate any needed organs and parts
Donate only specific organs and parts
Please specify specify which organs and/or tissues you would like to donate upon death?
Please enter the organs and/or tissues you would like to donate:
Do you consent to have your donated body, organs, and body parts used for any legal justification?
Select::
Yes
No
Do you wish to allow your donated body or donated organs and tissues to be used for transplantation?
Select:
Yes
No
Do you wish to allow your donated body or donated organs and tissues to be used for therapy (e.g., gene therapy)?
Select:
Yes
No
Do you wish to allow your donated body or donated organs and tissues to be used for study or research?
Select:
Yes
No
Do you wish to allow your donated body or donated organs and tissues to be used for medical education?
Select:
Yes
No
PDF Preview
Do you want to choose a primary healthcare provider?
Appoint Primary Physician?:
Yes
No
What are the name, phone number, and address of the primary care physician?
Enter Physician's Name:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
Would you like to include a different medical professional?
Alternate Physician:
Yes
No
What is the name, address, and phone number of the replacement physician?
Enter Alternate Physician's Name:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
PDF Preview
Who will serve as the first witness at the signing of this living will?
Enter Name:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
First Witness Signature
Select
Draw Signature
Upload Signature
Draw Signature
Upload Signature
Drop files here or
Select files
Max. file size: 2 MB, Max. files: 1.
Who will serve as the second witness at the signing of this living will?
Enter Name:
Enter Address:
Enter City:
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter Zip Code:
Enter Telephone Number:
Second Witness Signature
Select
Draw Signature
Upload Signature
Draw Signature
Upload Signature
Drop files here or
Select files
Max. file size: 2 MB, Max. files: 1.
Which state and which county will this living will be signed and/or filed in?
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Enter County Name:
What state's laws will apply to this contract?
Select State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
PDF Preview
PDF Preview
Login to your account
Email
Password
Forgot?
Log In
Don't have an account yet?
Create an account
Create a account
Email
Password
Check your email you can get the passsword, if you have already password then enter password and sign in to stubcreator account.
Next
Already have an account?
Log In