Wisconsin Living Will Form

The Wisconsin living will is a legal document that is completed by an individual (Principal) who is preparing for their end of life medical circumstances. The Principal, being of sound mind, will be able to use this document to set fourth instructions for their medical team and/or health care proxy so that it will be clear and in writing to ensure that their final medical wishes are honored when they are no longer able to communicate medical information on their own. This document after being prepared, may be revoked at the discretion of the Principal.

Laws – 154.01, et seq. Natural Death

How to Write

Step 1 – Download the document –

  • The Principal must carefully review and understand the first two pages of the form before proceeding

Step 2 – Declaration to Physicians –

  • Enter the Principal’s name
  • Read the remainder of the paragraph

Read the following statements and check only one response below each:

  • Terminal Condition
  • Persistent Vegetative State
  • Persistent Vegetative State (2nd)

Step 3 – Signatures –

  • The Principal must sign the document before two witnesses
  • Date the document in mm/dd/yyyy format
  • Complete address
  • Date of Birth in mm/dd/yyyy format

Witnesses – Read the witness statement. If in agreement, the witnesses must provide the following information:

  • Witnesses signatures
  • Date of signatures in mm/dd/yyyy format
  • Witnesses printed names

Read – Directives to Attending Physicians –

  • Read statements 1 through 4 in this section
  • In the lines below the physicians directives, enter the names of individuals who will have copies of this document