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Living Will / Advance Medical Directive

An Advance Medical Directive (also known as a Living Will) is a document, separate from the will, that provides instructions to your health care provider as to what you want done in the event that you become incapacitated and are in a terminal condition. This is your chance to tell your doctor if you want life support or not to help keep you alive. To ensure that doctors and hospitals follow the living will, one or two "agents" are appointed to act on behalf of the testator in health care matters. If the testator appoints two agents, he may require them to act jointly or he may permit the second to act only if the first cannot or will not act.

Living Will / Advance Medical Directive Questionnaire

Living Will / Advance Medical Directive (AMD) Questionnaire

Once you have completed the form, please mail the form to:

Ninth Coast Guard District (dl)
1240 East Ninth Street
Cleveland, Ohio 44199
Tel (216) 902-6010
Fax (216) 902-6055

Or, E-mail to: