Texas Living Will
This Living Will is created in accordance with Texas law to ensure your health care wishes are honored.
Personal Information
- Name: _______________________________
- Date of Birth: _______________________
- Address: ____________________________
Designation of Health Care Agent
I designate the following individual as my health care agent:
- Name: _______________________________
- Relationship: ________________________
- Phone Number: _______________________
Living Will Declaration
If I am diagnosed with a terminal condition or if I am in a state of irreversible coma:
- I do not want life-sustaining treatment if my attending physician determines that I am not expected to regain consciousness.
- I wish to receive comfort care and pain relief, even if it decreases my life expectancy.
Signature
By signing this document, I confirm that I am of sound mind and that I understand the contents of this Living Will.
- Signature: ___________________________
- Date: _______________________________
Witness Attestation
This document must be witnessed by two individuals who are not related to me, do not stand to benefit from my estate, and are not my health care providers.
- Witness Name: ______________________
- Witness Signature: __________________
- Date: ______________________________
Second Witness:
- Witness Name: ______________________
- Witness Signature: __________________
- Date: ______________________________
Please keep this document in a safe place and share copies with your health care agent and family members.