Arizona Living Will
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: _________________________
Designation of Health Care Agent
I hereby appoint the following individual as my health care agent:
Name of Agent: ______________________
Address of Agent: ____________________
Phone Number of Agent: ______________
Instructions Regarding Medical Treatment
In the event I am diagnosed with a terminal condition or am in a persistent vegetative state, I wish to provide the following instructions regarding my medical treatment:
- I do not wish to receive life-sustaining treatment if I am unable to make my own decisions.
- I wish to receive palliative care to alleviate pain and discomfort.
- I wish to be allowed to die naturally without artificial means of prolonging life.
Revocation of Prior Living Wills
This document revokes any prior Living Wills or advance directives that I have executed.
Signatures
Signed this ___ day of __________, 20__.
Signature: __________________________
Printed Name: ______________________
Witnesses
Two witnesses are required for this Living Will to be valid:
- Witness 1: ______________________
- Witness 2: ______________________
Each witness must be at least 18 years old and cannot be related to me by blood, marriage, or adoption, nor can they be entitled to any portion of my estate.
Notarization
While notarization is not required, it is recommended for additional validity.
Notary Public: ______________________