Preparing for What Matters is Part of the Legacy of a Life Well Lived

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Pre-Consultation Form

Date of Consultation*

Client 1 Information

Date of Birth*

Status*

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Client 2 Information

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1st Marriage *:*

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Additional Information

Children's data

Child's Full Name

Gender

Date of Birth

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Number of Grand Children

I have concerns about a Special Needs family member:*

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My estate has the following assets:*

IRA/Retirement Plans

Business/Partnerships

Stocks, Bonds, Mutual Funds

Life Insurance

Certificates of Deposit

In state real estate

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Approximate gross value of my entire estate

Do you work with a financial advisor/planner?

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Name of Financial Planner

Contact of Financial Planner

Please check one of the following boxes:*

I am ready to proceed with the creation of my plan.

My loved one is already in a nursing home, I am ready to proceed with a plan.

I am not interested in creating a plan at this time. I’m here for general information only.

I need the following questions answered before I am ready to proceed with the creation of my plan:

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What Really Matters to Me

Please rate the following estate planning goals and concerns on a scale of 1 to 10. (1 being “not important at all” and 10 being “very important.”)

Make sure there’s a written plan to handle my affairs*

Please enter a number from 1 to 10.

I want to avoid Living Probate and/or Death Probate*

Please enter a number from 1 to 10.

Make sure Nursing Home costs don’t use up all my assets*

Please enter a number from 1 to 10.

Make sure my wishes are honored regarding life support decisions*

Please enter a number from 1 to 10.

I want to minimize all Death Taxes*

Please enter a number from 1 to 10.

After my death, make sure my estate stays with my children if they get divorced*

Please enter a number from 1 to 10.

Protect my life insurance from Death Taxes*

Please enter a number from 1 to 10.

Protect my estate if Client 2 gets remarried after my death*

Please enter a number from 1 to 10.

After my death, protect my estate from my children’s creditors*

Please enter a number from 1 to 10.

Protecting my special needs child after my death*

Please enter a number from 1 to 10.

Funeral planning for my final arrangements and to make it easier for my family*

Please enter a number from 1 to 10.

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We help people define their goals, understand their risks, and put in place the planning, tools, and support needed for when they are no longer in control of their affairs due to incapacity or death.

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