Client Intake & Consent Form

Client Intake & Consent Form

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Filing Status
Primary Taxpayer Full Name

First NameLast Name
Primary Taxpayer Date of Birth

MonthDayYear
Date
Primary Taxpayer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Taxpayer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Primary Taxpayer Email Address
example@example.com
Primary Taxpayer Occupation
Primary Taxpayer Preferred Contact Method
Spouse Information
Spouse Full Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Email
example@example.com
Preferred Spouse Contact Method
Spouse Occupation
Same address as your spouse?
Months Lived with Spouse(Months separated, if applicable)
Spouse Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dependent Full Name

First NameLast Name
Relationship to Client
Months Lived with Client
Dependent Date of Birth

MonthDayYear
Date
Dependent Full Name

First NameLast Name
Relationship to Client
Months Lived with Client
Dependent Date of Birth

MonthDayYear
Date
Dependent Full Name

First NameLast Name
Relationship to Client
Dependent Date of Birth

MonthDayYear
Date
Months Lived with Client
Tax Documents Provided

Other
File Upload

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Other Documents Description
File Upload

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Health Insurance Marketplace.(Form 1095-A) Acknowledgment.

If you or anyone in your household had health insurance through the Health Insurance Marketplace (also known as Obamacare or Healthcare.gov), you are required by law to provide Form 1095-A before your tax return can be filed. If you choose not to upload this form or indicate that you do not have it, I/We cannot legally file your tax return. The IRS will not accept the return without accurate information from your Form 1095-A. If you cannot locate your Form 1095-A, please contact the Health Insurance Marketplace at 1-800-318-2596 to request a copy or download it from your Healthcare.gov account.
Did you or anyone in your household have Marketplace health insurance (Healthcare.gov) in 2025?”
File Upload

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Do you and your spouse have the same bank account?
Primary Taxpayer Bank Name
Primary Taxpayer Name on Account
Primary Taxpayer Account Type
Primary Taxpayer Account Routing Number
Primary Taxpayer Account Number
Spouse Bank Name
Spouse Name on Account
Account Type
Spouse Account Number
Spouse Routing Number
Representation and Audit Support
Authorization to Prepare and File
Responsibility for Accuracy
Communication Consent
Data Privacy and Confidentiality
Refund and Payment Acknowledgment
Consent for Record Retention
Date of Primary Taxpayer Signature

MonthDayYear
Date
Primary Taxpayer Signature

By signing below, I acknowledge that I have read, understood, and agree to all policies, authorizations, and consents outlined in this form. I certify that the information provided is true and that I have the legal right to file under the taxpayer name(s) listed above.
Date of Spouse Taxpayer Signature

MonthDayYear
Date
Spouse Signature (if applicable)

By signing below, I acknowledge that I have read, understood, and agree to all policies, authorizations, and consents outlined in this form. I certify that the information provided is true and that I have the legal right to file under the taxpayer name(s) listed above.
Should be Empty:

Client Intake & Consent Form

Spouse Information

Health Insurance Marketplace.(Form 1095-A) Acknowledgment.