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CLIENT INTAKE FORM
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What Year are you filing for?
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Please Select
2025
2024
2023
2022
2021
2020
2019
How did you hear about us?
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Referral
Previous Client
Type of Client
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Returning Client
New Client
Referred By:
What is the best day & time to contact you?
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Did you file a 2025 tax return?
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Yes
No
Unsure
Are you trying to buy a new home within the next 2 years?
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Yes
No
Taxpayer Information
Tax Payers Name
*
First Name
Last Name
Taxpayer's Phone Number
*
Example: xxx-xxx-xxxx
Occupation
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What is your County Name?
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What is the name of your school district?
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Taxpayer's Date of Birth
*
Example: 01/01/2001
Taxpayer's Email Address
*
Spouse Name
First Name
Last Name
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Spouse Occupation
Address
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does any of the following apply?
*
Deceased
Blind
Can Be Claimed As A Dependent
None of these apply
Date of Death
Ex. 01/01/2001
Please select each type of income that you received for the Year.
*
W2
Unemployment Income (1099G)
Self Employment (1099NEC/1099K/1099MISC)
Household Income (Home Health/Nanny)
1098T Filer
Interest Income
Alimony
No Income
Side Hustle
Due Diligence Questions
Are you self employed?
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Yes
No
Did you and your spouse live apart during the year?
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Yes
No
Not Applicable
What is your marital status as of December
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Single (Not Married)
Married living with Spouse
Married not living with spouse
Did you pay over half the expenses of maintaining your residence for the entire year?
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Yes
No
Did you support a child or family member for more than 6 months out of the year?
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Yes
No
If yes, did you live together at any time after June 30, 2025
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Yes
No
Not Applicable
Have you ever been denied the Earned Tax Credit (EITC)?
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Yes
No
Are you on any Government Assistance
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Yes
No
Not Applicable
Can someone else claim you as a dependent?
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Yes
No
I am the custodial parent for the dependent(s) for whom the tax credit(s) will be requested, and I released the dependency deduction to my former spouse for 2025 by signing Form 8332( release / Revocation of claim to exemption for Child by Custodial Parent).
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Yes
No
I or my child(ren) , have documentation to substantiate the credit(s) being claimed , such as form 1098-T , bills, statements, and receipts for college tuition, fees, books, and material cost (you are responsible for keeping this documentation and providing it to the IRS if you are audited or questioned).
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Yes
No
Was a child Tax Credit, Additional Child Tax Credit, or American Opportunity Credit claimed by you disallowed or reduced by the IRS on a past tax return?
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Yes
No
I am unmarried or separated, support a qualifying person as your dependent, and pay more than half the cost of maintaining your household.
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Yes
No
Are you on Section 8?
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Yes
No
Do you get Government Assistance?
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Yes
No
Does your yearly income exceed $17k/ year? *
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Yes
No
Dependent Information
How many dependents are you claiming?
*
Please Select
0
1
2
3
4
5
Are you claiming your own dependents?
Yes
No
Do you understand that if you are not claiming your own dependent that you will need a Notarized document from the parents/ guardian that you have permission to claim the child and why.
Yes
No
If you selected No, please provide the reason you are claiming someone else dependent.
Notarized Document from Dependents parent/guardian
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I certify that the child(ren) for whom the tax credit(s) will be requested can be claimed as my dependent(s), as per the information provided at the end this questionnaire.
Yes
No
Dependent #1
First Name
Last Name
Dependent #1 Date of Birth
01/01/2001
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2025? (If all year, enter 12)
Dependent #2
First Name
Last Name
Dependent #2 Date of Birth
Example: 01/01/2001
How many months did Dependent #2 live with you in 2025? (If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Dependent #3
First Name
Last Name
Dependent #3's Date of Birth
01/01/2001
How many months did Dependent #3 live with you in 2025? (If all year, enter 12)
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.
Yes
No
Upload a copy of your daycare form here.
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Upload A Utility Bill
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Upload A Lease Document
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Upload Your Last Year Tax return If You have It
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Refund Selection
Which of the following applies to you?
I paid a daycare or a nanny to care for my child 13 years or younger while I worked or looked for work. I can get a statement with their EIN/SSN to provide this claim
I attended a college/university/community college/post-secondary institution/career school and paid eligible expenses that can be proven with a 1098T form
I paid charity/tithes/or given donations to community organizations and/or religious institutions
I paid over $14,600 in expenses for itemization
I paid student loan interest and received a 1098E
I had eligible medical expenses
I had energy and solar power expenses
I sold and/or purchased a home
I adopted a child or had a baby
I am in the military and had to move
I got separated/divorced paid or received alimony
Out Of Pocket Expenses
Did You have any of the following
Insurance premiums you paid (medical, dental, vision)
Amount paid to providers (doctors, dentists, etc.) Prescriptions
X-rays, lab work, etc.
Nursing services (in-home or at a care facility)
Hospital care (including meals and lodging)
Alcohol and drug rehabilitation
Medical aids (hearing aids, crutches, wheelchairs, etc.)
Banking Information
How would you like to receive your tax refund?
Check (Only available for in office visits)
Direct Deposit
Green Dot Card
Name of Bank
Which type of account would you like your refund deposited into?
Checking Account
Savings Account
Health Insurance Information
Did you have health insurance in 2025?
Yes
No
Did you have health insurance for the entire year?
Yes
No
Who was your insurance coverage through in 2025?
Please Select
The Market Place
Employer
Medicaid
Was your insurance through Medicaid?
Yes
No
Was your insurance through the Affordable Care Act (The Marketplace)?
Yes
No
Did your dependents have health insurance for the entire year?
Yes
No
Not Appliable
Who was your Dependents insured with in 2025?
Please Select
Employer
Market Place
Medicaid
Upload Taxpayer & Dependent(s)Insurance Documents
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College Credit
Were you or any of your dependents in college in 2025?
Yes
No
Do you have a 1098-T Form for either you or your dependents?
Yes
No
If you have a 1098-T form, upload it here.
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Virtual Currency
Did you trade any Virtual Currency
Yes
No
Misc Services
Are you interested in AUDIT PROTECTION for 75.00?
*
Yes
No
Are you interested in Identity Theft Protection for 45.00?
*
Yes
No
Are you interested in a Cash Advance up to $7,000?
*
Yes
No
IRS Identity PIN Information
Were you issued an Identity Pin from the IRS
Yes
No
Identity Pin if Applicable
Taxpayer Signature (Required)
Date
-
Month
-
Day
Year
Date
Primary Taxpayer's Signature
*
Taxpayer's Signature (If no spouse, leave blank)
Date
-
Month
-
Day
Year
Date
Need to ask a Question??
If you have questions, please type them here.
Documents to be Uploaded-Please upload ALL requested info
Taxpayer's W-2/ 1099'S/ Socials/ Birth Certificates/ Picture of Direct Deposit Info/license
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Only as it applies: Self-Employment Expense Log, Summary if Income, Business License, Bank Statements, receipts, etc
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Healthcare Card for Taxpayer(s) and Dependent (s)
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