Estate Planning Intake Form

Your Contact Information

Full Name *

Phone *

Email

Client Information

Address

Spouse

Do you have a spouse?

Yes No

Spouse Name

Spouse Address

Spouse Phone

Children

Do you have children?

Yes No

Child #1

Name

Address

Is this child a minor?

Yes No

Child #2

Name

Address

Is this child a minor?

Yes No

Child #3

Name

Address

Is this child a minor?

Yes No

Executor

Executor Name

Alternate Executor

Real Estate

Do you own real estate?

Yes No

County of Property

Is the property held with Joint Rights of Survivorship?

Yes No

Bank Accounts

Are bank accounts held with Joint Rights of Survivorship?

Yes No

Specific Bequests

Power of Attorney

Do you want a Power of Attorney?

Yes No

POA Agent Name

POA Agent Phone

POA Agent Address

Alternate POA Agent Name

Alternate POA Agent Phone

Alternate POA Agent Address

Living Will

Do you want a Living Will?

Yes No

Healthcare Surrogate Name

Healthcare Surrogate Phone

Healthcare Surrogate Address

Alternate Healthcare Surrogate Name

Alternate Healthcare Surrogate Phone

Alternate Healthcare Surrogate Address

Additional Notes

Notes

Your Contact Information

Client Information

Spouse

Children

Executor

Real Estate

Bank Accounts

Specific Bequests

Power of Attorney

Living Will

Additional Notes

Ready to Schedule Your Consultation?