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Firm
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August 2013
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Powers of Attorney Questionnaire
Power of Attorney Questionnaire
Are you seeking a Power of Attorney for yourself?
Yes
No
Are you married?
Yes
No
What is your age?
The person creating/signing the document is called the principle and the person you are designating authority to act to is called the agent. Have you identified the person you would designate as an agent?
Yes
No
Have you identified an alternate agent?
Yes
No
Do you have any question as to the competency of the person you intend to designate as your agent or alternative agent?
Yes
No
Do you have a high level of trust in the person you intend to designate as your agent or alternate agent?
Yes
No
Do you have any concerns about the power of attorney that becomes effective immediately and not when you become incapacitated?
Yes
No
Acknowledgement
*
By submitting this form you acknowledge that you have read, understand and agree to the Disclaimer and Terms of Use. You further acknowledge that you understand that your submission of this form in no way creates an attorney client relationship and that such relationship can only be created by written agreement of both parties.
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Elder Law Questionnaire
Elder Law Questionnaire
What is your relationship to the person needing elder care?
Do you have any question as to the competency of the person you are seeking elder care for?
Yes
No
Does the individual have a power of attorney in place?
Yes
No
Where do they currently reside?
Would you like them to continue to reside at this location?
Yes
No
If yes, do they have long term care insurance?
Yes
No
Is there a home or other real estate you would like to protect?
Yes
No
If yes, has the property been transferred within the past five years?
Yes
No
If yes, how and in whose name is the deed titled? (sole ownership, joint tenancy, tenancy in common)
Acknowledgement
*
By submitting this form you acknowledge that you have read, understand and agree to the Disclaimer and Terms of Use. You further acknowledge that you understand that your submission of this form in no way creates an attorney client relationship and that such relationship can only be created by written agreement of both parties.
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Health Care Directives Questionnaire
Health Care Directives Questionnaire
Are you seeking a Healthcare Directive for yourself?
Yes
No
Do you already have a Healthcare Directive?
Yes
No
If yes, does it:
Include HIPPA protections?
Name all family members with equal power to make decisions?
Allows the withholding of life support?
Do you have adult children?
Yes
No
If you do not have a spouse or adult children or do not intend to designate any of them as your agent, do you have someone you are close with to designate as your agent?
Yes
No
Is the person you intend to designate as your agent in good health and able to function, including traveling to and from hospital, relatively easily and independently?
Yes
No
Have you considered giving your family members or those you are close to your end of life healthcare wishes?
Yes
No
Acknowledgement
*
By submitting this form you acknowledge that you have read, understand and agree to the Disclaimer and Terms of Use. You further acknowledge that you understand that your submission of this form in no way creates an attorney client relationship and that such relationship can only be created by written agreement of both parties.
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Will Questionnaire
Wills Questionnaire
Are you married?
Yes
No
If yes, is this your first marriage?
Yes
No
Do you have children?
Yes
No
What are the ages of your children?
Are any of your children married?
Yes
No
Do you have grandchildren?
Yes
No
Do any of your family members suffer from a disability or have any substance abuse issues?
Yes
No
Do you own real estate?
Yes
No
Is any of the real estate you own located out of Maryland?
Yes
No
Do you own or partially own a business?
Yes
No
Estates are taxable when they exceed $5.5 million. Will you need a plan that takes this into consideration?
Yes
No
Are your assets currently positioned to avoid going through probate?
Yes
No
I don't know
Additional Information
Acknowledgement
*
By submitting this form you acknowledge that you have read, understand and agree to the Disclaimer and Terms of Use. You further acknowledge that you understand that your submission of this form in no way creates an attorney client relationship and that such relationship can only be created by written agreement of both parties.
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