• INTAKE FORM

    Interview Quality Review Sheet

  • Disclaimer: Thank you for your interest in being a client of the Tax Office.

    This form is used to collect information about new, former, and current clients utilized for internal purposes only. The information you provide is confidential and will be treated accordingly.

  • Part I: Basic Information

  • Are you a returning client?
  • Are you a US Citizen?
  • Is Spouse a US Citizen?
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Your Date of Birth
     - -
  • Spouses Date of Birth
     - -
  • Are you Legally Blind?
  • Are you Totally and Permanently Legally Blind?
  • Spouse Legally Blind?
  • Spouse Totally and Permanently Legally Blind?
  • Can anyone claim you or your spouse on their tax return?
  • Did you receive a 1095A Health Insurance document?
  • Did you receive a PIN (Personal Identification Number) from the IRS?

  • Part II: Marital Status and Household Information

  • Marital Status

  • Dependents

  •       Pick a Date           
    Student     Yes                     

  •       Pick a Date           
    Student     Yes                  

  •       Pick a Date           
    Student     Yes                  

  •       Pick a Date
    Student     Yes                     

  • Source of Income:
  • Payment Method for Services:
  • If your method of payment is a Bank Product (which is paying for the service out of your refund) then select one.
  • If you're a 'New Client,' who may we thank for referring you?
  • Date
     - -
  • Should be Empty: