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Elder Law Client Information Form
To assist in the preparation of your planning documents, we request that you review and complete this questionnaire. In order to advise you we will need to know about the individual that we are planning for, their level of need and details regarding their asset picture. If you have any questions, feel free to contact us.
I. Getting To Know You
Information about the person completing this form:
Full Legal Name
Date of Birth
+
Address
City
County
Zip Code
Telephone
Home
Work
Mobile
Do we have permission to text this mobile number?
Yes
No
Email
Preferred Method of Contact
Phone
Email
Preferred Meeting Location:
Cary Office
Virtual- Conference Call
Virtual- Video Conference
Favorite Food/Drink
Hobbies
Information about the person needing Elder Law Planning:
Full Legal Name
Relationship:
Spouse
Parent
Grandparent
Friend
Other
Date of Birth
+
Marital Status:
Never Married
Married
Separated
Divorced
Widowed
Telephone
Home
Work
Mobile
Do we have permission to text this mobile number?
Yes
No
Email
Residents of North Carolina?
Yes
No
U.S. Citizen? If not US, then what country of citizenship?
Yes
No
No
Are you or the person we are planning for a Veteran?
Yes
No
If yes, what are the dates of service?
Please upload a copy of DD-214
Prior marriage?
Yes
No
Children from previous marriage?
Yes
No
Do you have children?
Yes
No
If yes, please complete the information below:
Full Legal Name
Date of Birth
Married? Y/N
Residence (City, State)
Adopted or From Previous Marriage?
1.
Full Legal Name
Date of Birth
Married? Y/N
Residence (City, State)
Adopted or From Previous Marriage?
2.
Full Legal Name
Date of Birth
Married? Y/N
Residence (City, State)
Adopted or From Previous Marriage?
3.
Full Legal Name
Date of Birth
Married? Y/N
Residence (City, State)
Adopted or From Previous Marriage?
4.
Full Legal Name
Date of Birth
Married? Y/N
Residence (City, State)
Adopted or From Previous Marriage?
5.
Full Legal Name
Date of Birth
Married? Y/N
Residence (City, State)
Adopted or From Previous Marriage?
6.
Full Legal Name
Date of Birth
Married? Y/N
Residence (City, State)
Adopted or From Previous Marriage?
Does any child require special needs or support?
Yes
No
If Yes, Please explain:
Do you have any grandchildren? If yes, please describe below.
Yes
No
If yes, please complete the information below:
Full Legal Name
Date of Birth
Parent Name
Adopted or From Previous Marriage?
1.
Full Legal Name
Date of Birth
Parent Name
Adopted or From Previous Marriage?
2.
Full Legal Name
Date of Birth
Parent Name
Adopted or From Previous Marriage?
3.
Full Legal Name
Date of Birth
Parent Name
Adopted or From Previous Marriage?
4.
Full Legal Name
Date of Birth
Parent Name
Adopted or From Previous Marriage?
5.
Full Legal Name
Date of Birth
Parent Name
Adopted or From Previous Marriage?
6.
Full Legal Name
Date of Birth
Parent Name
Adopted or From Previous Marriage?
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