Legacy Wealth Planning

1Your Information

2Children

3Additional Information

Your Information
First Name *(Required)
Last Name(Required)
Marital Status(Required)
- Married
- Unmarried
Email Address(Required)
Date of Birth *
MM slash DD slash YYYY
Client Gender
Spouse/Partner Information
Spouse/Partner’s First Name
Spouse/Partner’s Last Name
Spouse’s Email Address
Spouse/Partner’s Date of Birth
MM slash DD slash YYYY
Spouse Gender
Physical Address
Physical address line 1
Physical address line 2
Physical address city
Physical State
State
Physical address zip/postal code
Is your Mailing Address the same as Physical Address?
- My Mailing Address is the same
- My Mailing Address is different. I'd like to enter that address
Mailing Address
Mailing address line 1
Mailing address line 2
Mailing address city
Mailing State
State
Mailing address zip/postal code
Phone Number 1
Phone Number 1 Description
Phone 1 number
Add A Second Number
- Add Another Phone Number
Phone Number 2
Phone Number 2 Description
Phone 2 number
Add A Third Number
- Add Another Phone Number
Phone Number 3
Phone Number 3 Description
Phone 3 number

How many children do you have, living or deceased?
If you have more than 4 children let us know during the personal consultation.
Child 1
Child 1 First Name
Child 1 Last Name
Child 1 Date of Birth
MM slash DD slash YYYY
Child 1 Gender
Child 1 Email
Child 1 Phone
Child 1's Parent(s)
Child 1 Married?
- Yes
- No
Child 1's Children
Child 2
Child 2 First Name
Child 2 Last Name
Child 2 Date of Birth
MM slash DD slash YYYY
Child 2 Gender
Child 2 Email
Child 2 Phone
Child 2's Parent(s)
Child 2 Married?
- Yes
- No
Child 2's Children
Child 3
Child 3 First Name
Child 3 Last Name
Child 3 Date of Birth
MM slash DD slash YYYY
Child 3 Gender
Child 3 Email
Child 3 Phone
Child 3's Parent(s)
Child 3 Married?
- Yes
- No
Child 3's Children
Child 4
Child 4 First Name
Child 4 Last Name
Child 4 Date of Birth
MM slash DD slash YYYY
Child 4 Gender
Child 4 Email
Child 4 Phone
Child 4's Parent(s)
Child 4 Married?
- Yes
- No
Child 4's Children
Additional Children Information
Enter Additional Children Information

My estate has the following assets:
- Business/Partnerships
- Certificates of Deposit
- IRA/Retirement Plans
- Life Insurance
- Real Estate
- Stocks, Bonds, Mutual Funds
- Other
Please check one of the following boxes:
- I am ready to proceed with the creation of my plan.
- My loved one is already in a nursing home, I am ready to proceed with a plan.
- I am not interested in creating a plan at this time. I’m here for general information only.
- I need the following questions answered before I am ready to proceed with the creation of my plan:
Enter Additional Questions
Approximate gross value of my estate
I have concerns about a Special Needs family member:
- Yes
- No
What Really Matters to Me
Please rate the following estate planning goals and concerns on a scale of 1 to 10. (1 being “not important at all” and 10 being “very important.”)
Please rate the following estate planning goals and concerns on a scale of 1 to 10. (1 being “not important at all” and 10 being “very important.”)
Make sure there’s a written plan to handle my affairs
Please enter a number from 1 to 10.
Make sure Nursing Home costs don’t use up all my assets
Please enter a number from 1 to 10.
Make sure my wishes are honored regarding life support decisions
Please enter a number from 1 to 10.
I want to minimize all Death Taxes
Please enter a number from 1 to 10.
After my death, make sure my estate stays with my children if they get divorced
Please enter a number from 1 to 10.
Protect my life insurance from Death Taxes
Please enter a number from 1 to 10.
Protect my estate if my spouse gets remarried after my death
Please enter a number from 1 to 10.
After my death, protect my estate from my children’s creditors
Please enter a number from 1 to 10.
Protecting my special needs child after my death
Please enter a number from 1 to 10.
Funeral planning for my final arrangements and to make it easier for my family
Please enter a number from 1 to 10.

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Your Information

Spouse/Partner Information

Physical Address

Mailing Address

Phone Number 1

Phone Number 2

Phone Number 3

Child 1

Child 2

Child 3

Child 4

Additional Children Information

What Really Matters to Me

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