Texas Living Will
This Living Will is created in accordance with Texas state law regarding Advance Directives.
Personal Information:
- Name: ________________________________
- Date of Birth: ________________________
- Address: ______________________________
- City, State, Zip: _____________________
- Phone Number: ________________________
Declaration:
I, the undersigned, being of sound mind, willfully and voluntarily make this declaration in the event I become unable to communicate my wishes regarding my medical treatment:
If I am diagnosed with a terminal condition or an irreversible condition, I do not want my life to be prolonged by artificial means. I direct that:
- Life-sustaining treatment be withheld or withdrawn.
- Comfort care be provided to alleviate pain and distress.
Healthcare Proxy:
If I am unable to make my own health care decisions, I appoint the following person as my healthcare agent:
- Name: ________________________________
- Address: _____________________________
- Phone Number: ________________________
Witnesses:
This Living Will must be signed before two witnesses. The witnesses must not be related to me by blood or marriage and must not be entitled to any portion of my estate:
- Witness 1 Name: ______________________
- Witness 2 Name: ______________________
Signature:
By signing below, I affirm that I understand the contents of this Living Will and that I am making this decision voluntarily.
Signature: ______________________________
Date: __________________________________
This document reflects my wishes regarding medical treatment in alignment with Texas laws. It should be honored by my healthcare providers.