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Free Consultation

In anticipation of our phone conference for your fee free consultation, this form will assist you in compiling the information and documents necessary to determine if there is a need for Estate, tax or asset preservation planning and if our services can benefit them.

Please complete the following information. Then call our office to schedule the consultation or provide your telephone number below and we will call you.

Bold labels and This graphic indicates a required field. indicate required information.

Elder/Disabled Client Information

Select Residence

Contact Person Information
Do they have…

…a Will?

…a Power of Attorney?

…a Health Care Directive?

If you have supplemental Medicare insurance
What is their fixed montly income from
If they own a home

Have they made any transfers or gifts over $1,000.00 per year after 2/8/06?

If they have long term care insurance

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

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