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.Format: (000) 000-0000.
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
Beneficiaries
List of Beneficiaries
Are any of your children or intended beneficiaries physically or mentally challenged?
Do any of your children or intended beneficiaries have any special education, medical or financial needs?
Please Give Details
Other Information
Do you presently have a Will?
Living Trust?
Durable Power of Attorney?
Designation of Patient Advocate/Medical Durable Power of Attorney?
Is probate avoidance one of your estate plan objectives?
Additional Comments
Appointment
Should be Empty:

Estate Plan Customer Questionnaire