Living Will

Do you or your loved one need a Living Will?

Allow us to create the Living Will for you for a flat fee.*

Fill out our form online and make your payment on our website OR you can Book an Appointment now to meet in person or virtually.

This is not a Last Will & Testament. That can be found here.

*ALL fees and costs are subject to change without prior notice. All fees and costs quoted assume that the opposing party will sign an Acceptance of Service document. If the opposing party will not sign voluntarily then service of process fees will apply as follows: Acceptance of Service $0, Publication $125, Process Server $150.

Living Will

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What is the name of the person this Living Will is being created for (the Declarant)?

Declarant's Name:

First

Last

Is the Declarant male or female?

Declarant's Gender:

Female
Male

What is the Declarant's Phone Number?

Phone

What is the Declarant's address?

Address

Address Line 1

Address Line 2

City

State

Zip Code

What is the name of the person you appoint as your Advocate to make health care decisions on your behalf?

Enter Advocate's Name:

First

Last

What is the Advocate's address and telephone number?

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Would you like to appoint an Alternate Advocate in case the first is unable or unwilling to make healthcare decisions on your behalf?

Appoint Alternate Advocate:

Would you like to appoint a second Alternate Advocate?

Appoint Second Alternate Advocate:

Would you like to specify a date or state a condition that will start the Advocate's authority to make health care decisions for you?

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?:

Is there a Health Care Power of Attorney that will be attached to this Living Will?

Attach Health Care Power of Attorney:

Would you like to stipulate in this Living Will whether you wish to receive life-sustaining medical care if diagnosed with a terminal illness?

Specify care in case of terminal illness:

Would you like to stipulate in this Living Will whether you wish to receive or decline life-sustaining medical care if you fall into a permanent unconscious or vegetative state?

Specify vegetative care:

Would you like to stipulate in this Living Will whether you wish to receive or decline life-sustaining medical care if you fall into a marginally unconscious state but still unable to make decisions?

Specify marginally conscious care:

Would you like to stipulate in this Living Will whether you wish to receive or decline life-sustaining medical care if you are diagnosed with an untreatable condition or are in severe pain?

Specify care for untreatable condition:

Do you wish to receive or not receive CPR in an attempt to prolong your life?

Select Option:

Do you wish to receive or not receive life support (such as respirator or ventilator) in an attempt to prolong your life?

Select Option:

Do you wish to receive or not receive tube feeding in an attempt to prolong your life?

Select Option:

Do you wish to receive or not receive blood transfusions in an attempt to prolong your life?

Select Option:

Do you wish to receive or not receive surgery or invasive diagnostic testing in an attempt to prolong your life?

Select Option:

Do you wish to receive or not receive kidney dialysis in an attempt to prolong your life?

Select Option:

Do you wish to receive or not receive antibiotics or medications in an attempt to prolong your life?

Select Option:

Do you wish to receive or not receive maximum pain relief medication?

Select Option:

Do you wish to receive or not receive maximum pain relief medication even if it may hasten your death?

Select Option:

Do you wish to receive or not receive maximum pain relief medication even if it may cause a temporary addiction should you recover or survive your condition?

Select Option:

Do you wish to include any additional instructions on life-sustaining treatment or comfort care?

Additional Instructions?:

Please select from the options below all situations when you would choose not to prolong your life.

Do not prolong life if:

I have an incurable or irreversible condition
I become permanently unconscious or fall into a vegetative state
The risks and burdens of prolonging life outweigh the benefits

Would you like to specify who will be the Guardian in charge of your everyday needs in case you should need one?

Specify who will be your Guardian:

Would you like to appoint the Advocate in charge of your health care decisions as your Guardian?

Appoint your Advocate as Guardian?:

Upon death, would you like to donate any part of your body?

Make anatomical donation?:

Would you like to designate a primary health care physician?

Appoint Primary Physician?:

Would you like to include an alternate health care physician?

Alternate Physician:

Who is the first witness that will be present for the signing of this Living Will?

First Witness Name

First

Last

First Witness Address

Address Line 1

Address Line 2

City

State

Zip Code

First Witness Phone

Who is the second witness that will be present for the signing of this Living Will?

Second Witness Name

First

Last

Second Witness Address

Address Line 1

Address Line 2

City

State

Zip Code

Second Witness Phone

What is the Arizona county where this Living Will will be signed and/or filed?

Enter County Name:

Do you need to sign your living will?

Who will sign?

Living Will

Price: $125.00

Payment Method

Paypal
Stripe Credit/Debit Card

Paypal will open a new window after submission of document.

Location

Telephone

E-mail

Do you or your loved one need a Living Will?

Allow us to create the Living Will for you for a flat fee.*

Fill out our form online and make your payment on our website OR you can Book an Appointment now to meet in person or virtually.

This is not a Last Will & Testament. That can be found here.

What is the name of the person this Living Will is being created for (the Declarant)?

Is the Declarant male or female?

What is the Declarant's Phone Number?

What is the Declarant's address?

What is the name of the person you appoint as your Advocate to make health care decisions on your behalf?

What is the Advocate's address and telephone number?

Would you like to appoint an Alternate Advocate in case the first is unable or unwilling to make healthcare decisions on your behalf?

Would you like to appoint a second Alternate Advocate?

Would you like to specify a date or state a condition that will start the Advocate's authority to make health care decisions for you?

Is there a Health Care Power of Attorney that will be attached to this Living Will?

Would you like to stipulate in this Living Will whether you wish to receive life-sustaining medical care if diagnosed with a terminal illness?

Would you like to stipulate in this Living Will whether you wish to receive or decline life-sustaining medical care if you fall into a permanent unconscious or vegetative state?

Would you like to stipulate in this Living Will whether you wish to receive or decline life-sustaining medical care if you fall into a marginally unconscious state but still unable to make decisions?

Would you like to stipulate in this Living Will whether you wish to receive or decline life-sustaining medical care if you are diagnosed with an untreatable condition or are in severe pain?

Do you wish to receive or not receive CPR in an attempt to prolong your life?

Do you wish to receive or not receive life support (such as respirator or ventilator) in an attempt to prolong your life?

Do you wish to receive or not receive tube feeding in an attempt to prolong your life?

Do you wish to receive or not receive blood transfusions in an attempt to prolong your life?

Do you wish to receive or not receive surgery or invasive diagnostic testing in an attempt to prolong your life?

Do you wish to receive or not receive kidney dialysis in an attempt to prolong your life?

Do you wish to receive or not receive antibiotics or medications in an attempt to prolong your life?

Do you wish to receive or not receive maximum pain relief medication?

Do you wish to receive or not receive maximum pain relief medication even if it may hasten your death?

Do you wish to receive or not receive maximum pain relief medication even if it may cause a temporary addiction should you recover or survive your condition?

Do you wish to include any additional instructions on life-sustaining treatment or comfort care?

Please select from the options below all situations when you would choose not to prolong your life.

Would you like to specify who will be the Guardian in charge of your everyday needs in case you should need one?

Would you like to appoint the Advocate in charge of your health care decisions as your Guardian?

Would you like to appoint someone else to act as your Guardian?

What is name, address and telephone number of the person you would like to appoint as your Guardian?

Upon death, would you like to donate any part of your body?

Would you like to designate a primary health care physician?

What is the primary physician's name, address and telephone number?

Would you like to include an alternate health care physician?

What is the alternate physician's name, address and telephone number?

Who is the first witness that will be present for the signing of this Living Will?

Who is the second witness that will be present for the signing of this Living Will?

What is the Arizona county where this Living Will will be signed and/or filed?

Do you need to sign your living will?

Location

Telephone

E-mail