Find legal forms, law schools, and legal resources
Try “residential lease” — forms for your state are shown first.
West Virginia statutory health care form
Download the August 2026 West Virginia Living Will packet, the optional sample form under W. Va. Code § 16-30-4(g) for directing that life-prolonging intervention be withheld or withdrawn in a terminal condition. Get the form in editable Word and true fillable PDF. Add the completed sample PDF if you want a filled-in reference.
A state-specific living will packet, reviewed against the current West Virginia statute and ready for instant secure access.
Tracks the § 16-30-4(g) living will sample, including the post-2022 terminal-condition directions about CPR, ventilator, dialysis, and medically administered food and fluids.
West Virginia requires two qualified adult witnesses whose signatures are acknowledged with the principal before a notary public under § 16-30-4(a).
Complete the form on your device, then print and sign with two witnesses and a notary. Your personal details are never entered into an online form builder.
This download includes 1 document in editable Word and fillable PDF formats. Use the Word version for editing; the fillable PDF can be completed on screen, then printed and signed.
Review the complete form text below before purchasing. Your licensed download (editable Word and fillable PDF) is delivered after checkout.
STATE OF WEST VIRGINIA
LIVING WILL
The Kind of Medical Treatment I Want and Don't Want
If I Have a Terminal Condition
W. Va. Code § 16-30-4(g)
THIS LIVING WILL made this ______ day of ______________, 20____.
I, ____________________, being of sound mind, willfully and voluntarily declare that I want my wishes to be respected if I am very sick and unable to communicate my wishes for myself.
If I am very sick and unable to communicate my wishes for myself and I am certified by one physician, who has personally examined me, to have a terminal condition, I direct that life-prolonging intervention that would serve solely to prolong the dying process be withheld or withdrawn. I understand that by signing this document I am agreeing to the REMOVAL or REFUSAL of cardiopulmonary resuscitation (CPR), breathing machine (ventilator), dialysis, and medically administered food and fluids, such as might be provided intravenously or by feeding tube.
I give the following SPECIAL DIRECTIVES OR LIMITATIONS: ____________________
Signature of Principal / Address of Principal
Two witness attestation and notary acknowledgment of principal and witnesses.
Legal currency, verified
This West Virginia living will lets an adult direct that life-prolonging intervention be withheld or withdrawn if the adult has a terminal condition and cannot communicate, under the West Virginia Health Care Decisions Act, W. Va. Code § 16-30-1 et seq.
Tracks the optional living will sample form in W. Va. Code § 16-30-4(g), as updated by 2022 S.B. 470 for documents executed on or after January 1, 2023. Verified August 2026 against the West Virginia Code and the West Virginia State Bar 2022 living will form. It is not a government publication.
Sign in the presence of two adult witnesses, and have the principal and witnesses acknowledged before a notary public (W. Va. Code § 16-30-4(a)). Witnesses must not be related by blood or marriage, entitled to your estate, directly financially responsible for your medical care, your attending physician, or your medical power of attorney representative.
The complete statutory living will sample for a terminal condition, special directives lines, principal signature and address, two-witness attestation, and notary acknowledgment. A completed sample PDF is available separately as a filled-in reference.
Editable Word and true fillable PDF of the complete West Virginia Living Will. Customer support and lifetime update access are included with your purchase. A separate medical power of attorney or combined form is not included in this product.
This form is not legal advice. Consider speaking with a West Virginia licensed attorney about your situation.
ILRG is committed to top quality legal forms that are valid in all states. If you are not 100 percent satisfied after purchase, contact us for a full refund.
Yes. This packet tracks the optional living will sample in W. Va. Code § 16-30-4(g), as updated by 2022 S.B. 470 for documents executed on or after January 1, 2023. Verified in August 2026 against the West Virginia Code and the West Virginia State Bar 2022 living will form. It is not a government publication.
You sign in the presence of two adult witnesses, and the principal and witnesses must be acknowledged before a notary public (W. Va. Code § 16-30-4(a)). Witnesses must meet the statutory disqualification rules in § 16-30-4(b).
The statutory sample addresses a terminal condition and directs withholding or withdrawal of life-prolonging intervention that would serve solely to prolong dying, including CPR, ventilator, dialysis, and medically administered food and fluids, while keeping comfort care and oral food and fluids as desired and tolerated.
No. This product is the living will only. West Virginia also authorizes a separate medical power of attorney and a combined medical power of attorney and living will under § 16-30-4.
Both contain the same West Virginia living will text. Use the editable Word file to type details, or the fillable PDF to complete fields on screen. Print the finished document and sign on paper with two witnesses and a notary.