Living Will and Health Care Agent Template
Your medical wishes in writing, and the person who speaks for you.
Planning your own farewell? A living will tells doctors what you want if you cannot speak. A health care agent is the person who makes sure it happens. You need both. Fill this in while it is easy, sign it the right way for your state, and give copies to your doctor and your agent.
Planning for someone you love? If the person already has one, find it now and give it to the hospital. If they do not and can still decide, this template lets them say what they want. If they can no longer decide, ask the hospital about a surrogate under your state's law.
This is a general template, not legal advice. Laws differ by state, and most states publish their own advance directive form, which your doctors will recognize fastest. Have an attorney or your doctor review before signing.
Why you need both parts
A living will alone is a piece of paper in a drawer. It says what you want, but it does not say who is allowed to insist on it. A health care agent (some states say proxy or surrogate) is a person with legal authority to speak for you. Families argue at bedsides because one of these is missing. The template has both, and one signature covers them.
The decisions it asks you to make
- When it applies. A terminal condition, an end-stage condition, or permanent unconsciousness, as determined by two physicians.
- Life-prolonging treatment. None, a trial period, or everything available.
- Artificial nutrition and hydration. Withhold it, continue it, or leave it to your agent.
- Pain relief. The template says yes to comfort care even if it may hasten death, unless you say otherwise.
- Organ donation. Yes, limited, no, or your agent decides.
- Your agent and an alternate. Name, phone, address, and any limits on their authority.
There are no wrong answers. There are only unanswered ones.
Talk to your agent
A signed form nobody has discussed causes the fights it was meant to prevent. Sit down with the person you named and go through the checkboxes together. Then give them a copy, give your doctor a copy, and put a note in your wallet that says where the original is. The template includes a wallet card.
Signing it correctly
Most states require two adult witnesses, and most exclude your agent, your doctor, and anyone who would inherit from you. Some require a notary as well or instead. The State Requirements Guide has one row per state, a link to the official form where the state publishes one, and the witness and notary rule. If your state has its own form, use it and treat this template as your worksheet.
Preview the template
Free to use. Tell us where to send it, and the editable copy and the PDF arrive by email.
Related resources
Find help near you
Hospice teams and estate attorneys help people complete these every day. Find Hospice Care or Find Estate and Probate Attorneys