Consultation questionnaire

Estate Planning Consultation Questionnaire

The purpose of this form is to gather initial information to determine the scope of legal documentation to be recommended. We recognize that this questionnaire is a fairly intrusive document. However, the more complete the information is, the better it will equip us to develop the best possible estate planning alternatives. Your information will be kept confidential unless you expressly authorize, in writing, its release to others.

Information about you
Your Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
County*
Phone*
Email
Your date of birth*
Date Format: MM slash DD slash YYYY
Do you have any special needs, disabilities or serious medical conditions?*
- Yes
- No
Please describe
Do you currently have any of the following documents (check all that apply)?
- Will
- Trust
- Medical Power of Attorney
- Financial Power of Attorney
- Advanced Medical Directive/Living Will
- Guardianship for minors
- I'm not sure

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Information about your children
Please identify for each child:*
Full Name Age Date of birth Any special needs or disabilities?

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Type of property (rental home, land, etc.)	City/State?	Who owns the property?	How is title held?	Is there a mortgage?

Estate Planning Consultation Questionnaire

Step 1 of 6

Information about you

Family Information

Information about your spouse

Information about your children

Financial Information

Other Information

Full Name	Age	Date of birth	Any special needs or disabilities?