The Ala Firm
About
Book an appointment
Book FREE consultation
Family
Family
FAQ – Estate planning
Forms
Consultation questionnaire
Consultation questionnaire – MetLife
Financial power of attorney (POA)
Guardianship and Conservatorship Questionnaire
Guardianship election for minors
Individual pour-over trust
Last will and testament
Living will
Married couple trust package
Medical power of attorney (POA)
Probate Questionnaire
Home
Membership Account
Membership Billing
Membership Cancel
Membership Checkout
Membership Confirmation
Membership Invoice
Membership Levels
Parent Night
Request intake form
Guardianship and Conservatorship Questionnaire
Adult Guardianship and Conservatorship
Your full name (First, Middle Initial, Last):
Any other name(s) by which you have been known:
Your physical address:
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Your mailing address (if different from above):
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Your primary phone number:
Your alternate phone number (if any):
Your email address:
Full name of Proposed Ward (First, Middle Initial, Last):
(The Proposed Ward is the person over whom you are seeking guardianship and/or conservatorship)
What is the Proposed Ward's Date of Birth?
MM slash DD slash YYYY
What is your relationship to the Proposed Ward?
Proposed Ward's current physical address:
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What County does the Proposed Ward reside in?
Proposed Ward's current mailing address (if different from above):
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Proposed Ward's primary phone number:
Proposed Ward's alternate phone number (if any):
Proposed Ward's email address:
Identify all living children or parents of the Proposed Ward:
Full Name
Address (physical and mailing if applicable)
Telephone (and alt. tel. # if applicable)
Email
Relationship to Proposed Ward
Add
Remove
(To add more entries, select the plus sign to the right of the last column)
Please identify any person who has lived with the Proposed Ward for more than six (6) months in the last one (1) year:
Full Name
Address (physical and mailing, if applicable)
Telephone (and alt. tel. # if applicable)
Email
Relationship to Proposed Ward
Add
Remove
(To add more entries, select the plus sign to the right of the last column)
Please select which of the following documents the Proposed Ward has executed:
Medical Power of Attorney / Power of Attorney for Health Care
General Power of Attorney
Health Care Directive / Advance Directive (aka “Living Will”)
Last Will and Testament
Trust Agreement
Designated Beneficiary Agreement
Select All
(If any of the boxes are selected, please provide a copy to The Ala Firm).
Does the Proposed Ward have any other acting legal representative?
Yes
No
(For example, a representative payee, a trustee, a custodian of a trust, etc. not otherwise identified above)
Who?
Full Name
Address (both physical and mailing if applicable)
Telephone (and alt. tel. # if applicable)
Email
Type of Representative
Add
Remove
(To add more entries, select the plus sign to the right of the last column)
Name of Proposed Ward's current treating/primary physician:
If possible, please provide a letter from the treating physician supporting the request for guardianship and/or conservatorship.
Address of current treating/primary physician:
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone number of current treating/primary physician:
Identify any other treating physicians/caregivers:
Name
Provider Type
Address
Phone
Email
Add
Remove
(To add more entries, select the plus sign to the right of the last column)
Are you requesting Guardianship, Conservatorship, or Both?
Guardianship
Conservatorship
Both
Has a Guardian or Conservator been appointed for the Proposed Ward in the past?
Yes
No
Do you personally wish to be the Guardian for the Proposed Ward?
Yes
No
Full name of proposed Guardian (First, Middle Initial, Last)
Address of Proposed Guardian:
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone number of proposed Guardian:
Alternate phone number of proposed Guardian (if any):
Email address of proposed Guardian:
If your request for Guardianship is granted, will the Proposed Ward's address change?
Yes
No
I don't know yet
(For example, select “Yes” if you intend to relocate the Proposed Ward to an assisted living facility, nursing home, or other new living situation).
New physical address for Proposed Ward (if Guardianship is approved):
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Please describe the Proposed Ward's disabilities or impairments (physical and/or mental) which support your request for guardianship:
Do you wish to personally be the Conservator for the Proposed Ward?
Yes
No
Full name of proposed Conservator (First, Middle Initial, Last)
Address of proposed Conservator:
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone number of proposed Conservator:
Alternate phone number of proposed Conservator (if any):
Email address of proposed Conservator:
Please describe the Proposed Ward's disabilities or impairments (physical and/or mental) which support your request for conservatorship:
List all known assets of the Proposed Ward:
Description of Asset
Estimated Value
Add
Remove
This is required on the petition to be filed with the Court. For example, bank accounts, property, pensions, insurance, retirement accounts.
List all known income of the Proposed Ward:
Description of Income
Estimated Amount
Add
Remove
This is required on the petition to be filed with the Court. For example, social security, pension, insurance, annuities, etc.
Δ