Arizona Living Will

You can fill out the form here: 📄 Arizona Short Form Living Will and POA (PDF)

Step-by-step Instructions

Section 1: My Information

What it asks:

• Your full legal name

• Birthdate

• Address

• Phone number

Helpful Tip: Use your full legal name as it appears on your ID or medical records. This ensures the document can be properly matched to you.

Section 2: My Choices for End-of-Life Care

What it asks: This is the heart of the living will. You will be asked to choose whether or not you want certain life-sustaining treatments if you are unable to speak for yourself and are near death.

You’ll make selections for the following situations:

• CPR (Cardiopulmonary resuscitation): Do you want to be resuscitated if your heart stops?

• Artificial nutrition and hydration: Do you want a feeding tube or IV fluids?

• Pain relief: Do you want pain medication, even if it may speed up death?

Helpful Tip: These decisions are deeply personal. You may want to speak with a doctor, family member, or spiritual advisor. You can also update this document at any time if your preferences change.

Section 3: Additional Instructions (Optional)

What it asks: This is a free-text space to include any other specific wishes related to your care. For example:

• “I want music played in my hospital room.”

• “Please allow my pet to visit, if possible.”

• “No chemotherapy if I have terminal cancer.”

Helpful Tip: Use clear, specific language. This section helps personalize your care and give your loved ones guidance.

Section 4: Signature and Witnesses

What it asks:

• Your signature and the date

• Two witnesses’ names, signatures, and dates

• OR a notary’s signature and seal

Helpful Tip: You only need either two witnesses OR a notary, not both. Your witnesses must be adults and should not be your healthcare provider or someone who could financially benefit from your estate.

🧾 What to Do After You Complete the Form

1. Make Copies Keep the original in a safe but accessible place. Share copies with:

   • Your healthcare provider

   • Your designated healthcare power of attorney (if you have one)

   • Close family or friends

2. Consider Registering It Arizona has a free registry for advance directives. You can register your living will with the Arizona Healthcare Directives Registry for easy access by healthcare providers. Register your directive →

3. Review Annually Update the document as your preferences or health conditions change. Even if your wishes stay the same, re-signing annually can show that your decisions are still current.

🛠️ Need Help?

If you want support filling this out, or have questions about how it fits into your larger care plan, Helpful can walk you through it or connect you with someone who can.