Iowa Living Will Form (Advance Directive)

The Iowa Advance Directive For Health allows the principal to make decisions applying to the medical treatment they receive if they become incapacitated through an illness such as Alzheimer`s disease or Dementia. If the principal wishes to specify treatments or special conditions they are able to do so. This document requires attestation by two (2) witnesses and a notary public in accordance with § 144B.3.

How to Write

Declaration Relating To Life Sustaining Procedures

The principal must carefully read the document and then complete the relevant blank fields.

Life Sustaining Procedures

The principal must express their wishes regarding life sustaining procedures.

  •  Check box for `Yes` or `No` regarding sustain of life.
  • Enter date.
  • Signature.
  • Print name.
  • Date of birth.
  • Address.



The details of two witnesses must be entered.

  • County of declaration.
  • Date.
  • Name of notary.
  • Signature of notary.
  • Signatures of witnesses.
  • Names of witnesses.
  • Addresses of witnesses.