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Intake Form for Will Plans
Personal and Family information Form
Please complete and click submit.
Name
First
Middle
Last
Maiden name (if applicable)
Date of Birth
MM slash DD slash YYYY
Cell Phone
Email
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
Marital Status
Single
Married
Divorced
Widowed
Date of marriage
MM slash DD slash YYYY
Date of divorce
MM slash DD slash YYYY
Spouse date of death
MM slash DD slash YYYY
Name of Spouse
First
Middle
Last
Maiden name (if applicable)
Date of birth
MM slash DD slash YYYY
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?
Yes
No
Number of children
Please enter a number from
1
to
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
Max. file size: 200 MB.
Copy of your spouse's driver's license
Max. file size: 200 MB.
Copy of your marriage license
Max. file size: 200 MB.
Copy of passport(s) or other identification for your children
Drop files here or
Select files
Max. file size: 200 MB.
Power of attorney
Drop files here or
Select files
Max. file size: 200 MB.
Healthcare Documents
Drop files here or
Select files
Max. file size: 200 MB.
Trust Documents
Drop files here or
Select files
Max. file size: 200 MB.
Existing Wills and Codicils
Drop files here or
Select files
Max. file size: 200 MB.
Life insurance contracts
Drop files here or
Select files
Max. file size: 200 MB.
Any additional relevant information
