Who will make your medical decisions when you can't?

Living Will & Medical Power of Attorney

Care if in Terminal Condition

Select which forms of medical care do you want IF your condition is terminal with no reasonable hope of recovery?

Select which types of care you wish to receive:

Life Support

Tube feeding (food and water)

Comfort care

None of the above

Your Information

Who is this Living Will being created for?

Gender Female Male

(e.g. James Tiberius Smith)

(e.g. 47 Grosvenor Avenue)

Your 1st Health Care Agent

If you are unable to care for yourself, who do you want to make health care decisions for you?

(e.g. brother, wife, friend, etc.)

Would you like to name an alternative health care agent in case your 1st health care agent is unavailable?

Yes No

(e.g. brother, wife, friend, etc.)