Estate Planning

Estate Planning Questionnaire

    Contact Information

    Your Name

    Spouse's Name

    Street Address

    City

    State

    ZIP)

    Phone

    Your Email (required)


    How many children do you have?

    Are any of your children under 18?
    YesNo

    Are you currently employed?

    Inventory of Assets

    Safe Deposit Box
    YesNo

    Life Insurance Policy
    YesNo

    Real Estate in Florida
    YesNo

    Real Estate outside of Florida
    YesNo

    Brokerage Account
    YesNo

    Retirement Account
    YesNo

    Annuity
    YesNo

    Long Term Health Care Insurance
    YesNo

    Checking/Money Market Account
    YesNo

    Savings Account
    YesNo

    Certificate of Deposit
    YesNo

    Automobile
    YesNo

    Current Estate Plan

    Pick One:

    Have arrangements been made for any of the following?

    Durable Power of Attorney
    YesNo

    Health Care Surrogate Delegation
    YesNo

    Living Will Delegation
    YesNo

    What would be the most convenient time for us to contact you?