New Client Intake Form | Rapps & Associates, PLLC

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Prospective Client Information Form

Name
First Middle Last
Cell Phone
Email
Fax
Address
Street Address Address Line 2 City State ZIP Code
Marital Status
Name of Spouse
First Middle Last
Spouse Cell Phone
Spouse Email
Do you have children?
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
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
Document Upload
Drop files here or

Max. file size: 200 MB.
Who referred you to our office?
Do you have additional questions or need more information?