Healthcare Travelers

Tax Preparation Digital Intake Form

Thank you for choosing our tax preparation services. Please complete the following form to provide us with the necessary information for your tax preparation.
Client Information
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Tax Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Job Title
Tax Information
Tax Year
Filing Status

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)
Dependents
Income

Please provide the following income information for the tax year.
Wages, Salaries, Tips, etc.
Interest Income
Dividend Income
Other Income
Total Income During the Fiscal Year $
Deductions

Please provide the following deduction information for the tax year.
Standard Deduction
Itemized Deductions
Credits

Please provide the following credit information for the tax year.
Child Tax Credit
Education Credits
Other Credits
Additional Information
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Tax Preparation Digital Intake Form