Elder Law & Long-Term Care Planning Intake
Complete the brief form below to tell us about your elder law needs, whether you are seeking assistance for yourself or a loved one. Our office will review your information and contact you to discuss next steps.
Contact Information
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
*
Phone
Email
Text Message
Illinois County
*
Please Select
Cook
Will
DuPage
Lake
Kane
Kankakee
Grundy
Other Illinois county
Outside Illinois
Who Needs Legal Assistance?
Who is this inquiry for?
*
Myself
My parent
My spouse
Another family member
Someone I assist as power of attorney or guardian
Other
Other person's full name
*
First Name
Last Name
Can this person participate in legal discussions and decisions?
*
Yes
No
Unsure
Do you currently have legal authority to act on this person's behalf?
Yes, power of attorney
Yes, court-appointed guardian
No
Unsure
Legal Assistance Needed
Type of elder law assistance sought
*
Long-term care planning
Medicaid planning or eligibility questions
Nursing home or assisted living planning
Powers of attorney or advance directives
Adult guardianship
Wills, trusts, or estate planning
Asset preservation or financial planning considerations
Legal decision-making for an aging parent or loved one
Reviewing or updating existing legal documents
Not sure — need guidance
Other
Current situation
*
Planning ahead for future needs
An older adult is beginning to need assistance
Considering nursing home or assisted living care
Long-term care is already being provided
A recent health or family change requires legal planning
Facing an immediate legal concern
Other
Existing legal documents or court proceedings
*
Yes, powers of attorney or advance directives
Yes, will or trust
Yes, guardianship or another court proceeding
Yes, multiple documents or proceedings
No
Unsure
Brief description of your situation
Timing & Next Steps
How soon is legal assistance needed?
*
Immediately — urgent legal concern
Within the next 1–2 weeks
Within the next month
Planning ahead — no immediate deadline
Is there an upcoming court date, Medicaid deadline, or other important legal deadline?
*
Yes
No
Unsure
Deadline date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Brief explanation of the deadline or upcoming event
Acknowledgment & Submission
Acknowledgment
*
I understand that submitting this intake form does not establish an attorney-client relationship or guarantee legal representation. I understand that the firm will review my inquiry and contact me regarding potential next steps.
Consent
I agree to receive follow-up communications about my inquiry.
Submit
Should be Empty: