Intake Form for Will Plans

Name

First Middle Last

Maiden name (if applicable)

Date of Birth

Cell Phone

Email

Address

Street Address Address Line 2 City State ZIP Code

Marital Status

Date of marriage

Date of divorce

Spouse date of death

Name of Spouse

First Middle Last

Maiden name (if applicable)

Date of birth

Spouse Cell Phone

Spouse Email

Do you (or your spouse) have any of the following?

Will
Designated Standby Guardian for Minor Children
Trust
Power of Attorney
Health Care Proxy
Living Will
Life Insurance
None of the above

If you checked yes to any of the above, please provide details and please upload copies of existing documents using the Choose File button at the end of this form.

Do you have children?

Number of children

Please enter a value between 1 and 6.

First child full name and DOB

Second child full name and DOB

Third child full name and DOB

Fourth child full name and DOB

Fifth child full name and DOB

Sixth child full name and DOB

Are any of your children under the age of 18?

Yes
No

Name of first choice for guardian

First Middle Last

Contact information

Relationship

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Email

Would you like to name a second/alternate guardian for your children?

Yes
No

Name of second choice for guardian

First Middle Last

Contact information

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Email

Trustees

Name, relationship, phone and address of your first and second trustees for any trusts created by your will. If your spouse will be your first choice please indicate. Please note, when the trust is for the benefit of minor children, some people may name the guardian as trustee, however, you may name someone else if you would like.

Trustees (spouse)

Name, relationship, phone and address of first and second trustees for any trusts created by your spouse's will. If you will be the first choice for your spouse please indicate. Please note, when the trust is for the benefit of minor children, some people may name the guardian as trustee, however, you may name someone else if you would like.

Will we be preparing a healthcare proxy for you?

Yes
No

Name, relationship, phone and address of your first and second healthcare agent. If your spouse will be your first choice please indicate.

Will we be preparing a healthcare proxy for your spouse?

Yes
No

Name, relationship, phone and address of your spouse's first and second healthcare agent. If you will be your spouse's first choice please indicate.

Will we be preparing a durable power of attorney (for financial decisions) for you?

Yes
No

Name, relationship, phone and address of your first and second agent(s) under your durable power of attorney. If your spouse will be your first choice please indicate.

Will we be preparing a durable power of attorney (for financial decisions) for your spouse?

Yes
No

Name, relationship, phone and address of your spouse's first and second agent(s) under their durable power of attorney. If you will be the first choice please indicate.

Copy of your driver's license

Copy of your spouse's driver's license

Copy of your marriage license

Copy of passport(s) or other identification for your children

Drop files here or

Power of attorney

Drop files here or

Healthcare Documents

Drop files here or

Trust Documents

Drop files here or

Existing Wills and Codicils

Drop files here or

Life insurance contracts

Drop files here or

Any additional relevant information

HAVE A QUESTION? WE WILL CALL YOU!

Personal and Family information Form

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