Fee Free Consultation

In anticipation of our phone conference for your fee free consultation, this letter 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 information, provide to us and keep a copy. Then call our office to schedule the consultation or provide your telephone number below and we will call you.

Bold labels and indicate required information.

Free Consultation Form

Name & age of elder/disabled clients; present health status; at home or in facility; number and ages of children:

Name of contact person:

Phone of contact person:

Email of contact person: Please enter a valid e-mail address.

Do they have a Will, Power of Attorney, Health Care Directive?

When are they dated?

If you have supplemental Medicare insurance, name of company and amount of monthly premium:

What is their fixed monthly income from Social Security

, pension , other (annuity, etc.)

If they own a home, what was the original purchase price; the current sales value; the balance due on mortgage/equity line of credit?

IRA/401(k) retirement plan value:

In addition to the home and IRA, what is the estimated value of all other assets (bank accounts, stocks, bonds, etc.)?

Have they made any transfers or gifts over $1,000.00 per year after 2/8/06? Select an Option Yes No If so, how much & when?

Are they still filing Federal Income Tax?

Select an Option Yes No

What is the face amount of any private life insurance policies?

If they have long term care insurance, what is the daily benefit amount?

Years of coverage?

• Elder Law & Asset Protection
• Medicaid Planning
• Top 10 Medicaid Mistakes
• Wills & Estate Planning
• Power of Attorney
• Living Will
• Guardianship & Conservatorship
• Probate Administration
• Probate It Yourself
• Probate Litigation
• Real Estate Law
• What is a Certified Elder Law Attorney?

• VA Benefits and Entitlements
• Testimonials
• Fee Free Consultation

McHugh & Macri
49 Ridgedale Avenue
East Hanover, NJ 07936
Phone: 973-577-6010
Fax: 973-887-6237
Map and Directions

Fee Free Consult Available
Credit Cards Accepted