Connecticut Living Will Form

The Connecticut living will is a legal document that is created by a Principal who would like to provide their wishes in writing in the event they would become incapacitated to the point that they would no longer have the ability to communicate their wishes with regard to their end of life decisions with the health care providers, privately. The document will require the signatures of two witnesses. As long as the Principal is of sound mind, they may revoke this document at any time.

Laws – Sec. 19a-570

How to Write

Step 1 – Download the document. The Principal must read and agree to the first paragraph of the document before proceeding, then enter:

  • The Principal’s name

Step 2 – Specific Instructions –

  • The Principal must review this paragraph and then select whether the Principal would like to have the services provided or withheld
  • Should the Principal have other specific requests enter, the requests/instructions into the lines provided on the form. If more space is required, add a continued sheet, sign and date it and attach it to this form

Step 3 – Pain Medication – If the Principal would like sufficient pain medication, read the statement and then provide:

  • Date of signature in mm/dd/yyyy format
  • Principal’s signature

Step 4 – Witness Statements – The witnesses must read and agree to the paragraph provided. Once read and if in agreement:

  • Enter the Principal’s name in the line at the top of the statement
  • Under the paragraph, the witnesses must enter their respective information as follows:
  • Witnesses Signatures
  • Street Addresses
  • City
  • State
  • Zip Code
  • OR
  • Scroll down to use the witness/ notary form – If this form is utilized, the witnesses shall sign in the presence of each other. Tough optional, the notary shall acknowledge the document by providing all information and affixing the official seal (if any).