Estate Planning Client Questionnaire

Estate Plan Customer Questionnaire

Thank you for choosing us for your estate planning needs. Please fill out this questionnaire to help us understand your requirements.
Personal Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Occupation*
Employer*
Marital Status*

SingleMarriedDivorcedWidowed
Beneficiaries
List of Beneficiaries
Are any of your children or intended beneficiaries physically or mentally challenged?

YesNo
Do any of your children or intended beneficiaries have any special education, medical or financial needs?

YesNo
Please Give Details
Other Information
Do you presently have a Will?

YesNo
Living Trust?

YesNo
Durable Power of Attorney?

YesNo
Designation of Patient Advocate/Medical Durable Power of Attorney?

YesNo
Is probate avoidance one of your estate plan objectives?

YesNo
Additional Comments
Appointment*
Should be Empty:

Estate Plan Customer Questionnaire