Estate Planning Questionnaire - Individual
Our office focuses on assisting individuals and families in capturing their wishes in a well prepared estate plan that contains the provisions necessary to deal with the events of life that you can envision, and those you cannot. If a particular question does not apply to you, please insert N/A or NA. This questionnaire is a CONFIDENTIAL form.

* This questionnaire is on Google Forms, which is a platform that uses an SSL Certificate connection making your private information unreadable to everyone except for the server you are sending the information to.
** Completing this form does not create an attorney-client relationship. A separate written agreement must be reached with our firm.

Biographical Information
Full Legal Name
Your answer
Name you prefer to be called
Your answer
Date of Birth
MM
/
DD
/
YYYY
Home Address (Street, City, State, and Zip Code)
Your answer
County of Residence
Your answer
Home Phone
Your answer
Cell Phone
Your answer
E-mail Address
Your answer
Where is the best place to reach you?
Your answer
Employment Information
Employer
Your answer
Occupation
Place of Employment (Street, City, State, and Zip Code)
Your answer
Work Phone
Your answer
Work Fax
Your answer
Work E-mail
Your answer
Children
Child 1: (Name, Age, Address, and Phone Number)
Your answer
Child 2: (Name, Age, Address, and Phone Number)
Your answer
Child 3: (Name, Age, Address, and Phone Number)
Your answer
Child 4: (Name, Age, Address, and Phone Number)
Your answer
Child 5: (Name, Age, Address, and Phone Number)
Your answer
Other Children: (Name, Age, Address, and Phone Number)
Your answer
Do any of the children have special needs?
If any of the children have special needs, please provide name and describe condition.
Your answer
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