Arkansas Living Will Template
This Living Will is created in accordance with Arkansas law regarding advance directives. It allows you to express your wishes regarding medical treatment in the event that you become unable to communicate your preferences.
Personal Information:
- Name: ____________________________________
- Date of Birth: _____________________________
- Address: ___________________________________
- City, State, Zip: __________________________
Declaration:
I, the undersigned, being of sound mind, willfully and voluntarily make this declaration to provide guidance to my family and healthcare providers regarding my medical treatment preferences in the event that I am unable to make decisions for myself.
Medical Treatment Preferences:
If I am diagnosed with a terminal condition or a condition that renders me permanently unconscious, I wish for the following:
- To receive life-sustaining treatment:
- To receive comfort care only:
- To receive no treatment:
Additional Instructions:
__________________________________________________________________________
__________________________________________________________________________
Designation of Healthcare Proxy:
If I am unable to make my own healthcare decisions, I appoint the following individual as my healthcare proxy:
- Name: ____________________________________
- Phone Number: _____________________________
- Address: ___________________________________
Signature:
By signing below, I confirm that I understand this Living Will and that it reflects my wishes regarding medical treatment.
Signature: _______________________________ Date: _______________
Witness 1: _______________________________ Date: _______________
Witness 2: _______________________________ Date: _______________
This document must be signed in the presence of two witnesses who are not related to you by blood or marriage, and who are not entitled to any portion of your estate.