Free Arkansas Living Will Form

An Arkansas living will is a written document that lets an individual of sound mind, at least eighteen years of age, state their wishes for life-sustaining treatment in advance.[1.1] This applies if you later become terminally ill or permanently unconscious and cannot communicate your decisions. It mainly addresses whether to use or refuse treatments such as CPR, tube feeding, or a ventilator.

Last Updated: September 2026. This guide is reviewed and updated regularly to reflect current Arkansas law. If you notice an error or outdated information, please contact us.

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To be valid, sign the living will yourself, or have someone sign it in your presence at your direction, in front of two witnesses.[1.3]

Signing Requirements and Laws

Arkansas living wills are governed by the Rights of the Terminally Ill or Permanently Unconscious Act. Under Ark. Code Ann. § 20-17-202, the declarant must sign the document, or have someone sign it in their presence and at their direction, and two witnesses must also sign it.[1.3]

  • The declarant signs the document, or someone else signs it in the declarant’s presence and at the declarant’s direction.[1.3]
  • Two witnesses must also sign, unless the document is instead acknowledged before a notary public.[1.3]
  • Each witness signs a statement that the declarant voluntarily signed the document in the witness’s presence.[1.3]

An Arkansas living will is also called an advance directive or an advance care plan. These plans record your wishes before a medical crisis.

Please note: Arkansas law allows a living will to be witnessed by two people or acknowledged before a notary public.[1.3] The Arkansas living will form provided on this page only includes a witness acknowledgment, so choose two qualified witnesses to sign it.

Arkansas law also provides sample declaration wording in § 20-17-202(b) that you may use, though you are not required to use that exact language.[1.2] A standardized template, like the one below, makes it easier to include every required element.

Arkansas residents may also create a health care power of attorney to name a health care agent who can make medical decisions on their behalf.

You may revoke your declaration at any time and in any manner, whatever your mental or physical condition. The revocation takes effect once you, or a witness to the revocation, tell your attending physician or other health care provider (Ark. Code Ann. § 20-17-204(a)(1)).[1.4]

Arkansas Living Will Form Details

Document Name Arkansas Living Will Form
State Form Name Arkansas Advance Care Plan Form
Signing Requirements Two Witnesses
Validity Requirements Ark. Code Ann. §§ 20-17-202 to 20-17-203
State Laws: Arkansas Code Ann. § 20-17-202

Does a Living Will in Arkansas Require the Declarant’s Signature?

Yes. Under Ark. Code Ann. § 20-17-202, an Arkansas living will must be signed by the declarant, or by someone else at the declarant’s direction, and it must be witnessed by two individuals.[1.3] This signature and witness requirement applies whether you use the statutory sample language or a standardized template like the one on this page.


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How Do You Fill Out the Arkansas Living Will Form?

The Arkansas living will and medical power of attorney form combines your health care wishes and, optionally, a health care agent designation in one document. Follow the steps below in order, using the page numbers to find each part of the form.

  1. Living Will/Advance Health Care Directive Declaration (page 2). Fill in the date, your name, and your residence address at the top of the declaration.
  2. Health Care (page 2). Initial each treatment to withhold if incapacitated, such as CPR, tube feeding or IV nutrition, ventilation, dialysis, blood transfusions, organ transplants, or other artificial life-sustaining treatment.
  3. End-of-Life Care (page 2). Initial the conditions under which life-prolonging treatment should stop, such as an inability to communicate combined with total dependency, a deteriorated mental condition, an end-stage condition, a terminal condition, or a physician-confirmed vegetative state.
  4. Anything Else You Want to Add (Optional) (page 3). Add any other health care wishes not already covered, or leave this section blank.
  5. Medical Power of Attorney, Agent (page 3). Enter your name as the principal, then appoint your health care agent by entering their name, address, and phone number.
  6. If Your Agent Cannot Serve (page 4). If your first choice cannot serve, enter the name, address, and phone number of a substitute agent.
  7. Agent’s Powers and Standard Provisions (page 4). Review the listed powers and the standard provisions on the effective date, HIPAA release, agent duties, revocation, and severability. No entries are needed here.
  8. Signature (page 8). Date and sign the document, and print your name, in the signature block.
  9. Witness Acknowledgment (page 8). Sign before two witnesses who are not your agent or health care provider. Each witness prints their name and address, then signs and dates the form.

After signing, give copies to your physician, your named healthcare agent, and any close family members who should know your wishes.

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Other Arkansas Forms
Below are various other Arkansas templates completed by our users. Try our simple builder to customize these forms to your preferences.

General information, not legal or tax advice.

Sources

  1. Ark. Code Ann. 20-17-202(a)(1) §§ Ark. Code Ann. 20-17-202(a)(1), Ark. Code Ann. 20-17-202(b), 20-17-202.
    • 1.1 Ark. Code Ann. 20-17-202(a)(1)
    • 1.2 Ark. Code Ann. 20-17-202(b)
    • 1.3 § 20-17-202
    • 1.4 § 20-17-204(a)(1)
Published: Jun 18, 2024
Mara Erlach
Mara Erlach
Writer & Attorney
Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.