New Tax Client Intake Form

New Client Intake Form

Tax Year: 2024
What was your filing status last year?

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying WidowerNot Sure

Taxpayer 1 Information
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at this address?
# of years
Employment Status

EmployedUnemployedSelf-employed
Occupation
Are you a full-time student?

YesNo
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo
Please upload a copy of your unexpired driver's license for verification purposes.

Cancelof

Taxpayer 2 Information
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at this address?
# of years
Employment Status

EmployedUnemployedSelf-employed
Occupation
Are you a full-time student?

YesNo
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo
Please upload a copy of your unexpired driver's license for verification purposes.

Cancelof

Enter your dependents here

Did you, your spouse, and your dependents have health insurance all 12 months last year? If yes, who covers you for it?

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Bank/Investment Interest
Cash Contributions to Charity
Non-Cash Contributions to Charity
Unreimbursed Business Expenses
Union Dues

New Client Intake Form