Planning Questionaire

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SIMPLE BACKGROUND INFORMATION

If you would like to meet with us, please complete the form below.

Qualifying for Medicaid requires a lot of facts. “Just the facts, Ma’am”, as Sargent Friday used to say. The form below asks for a lot of facts. Medicaid is fact intensive – we can’t just guess. Even if you just came in to the office, we would have to have the information in the following form before we could even have an intelligent conversation with you. It will probably take about an hour to complete this form. Yes, I know you don’t have time, but if you have a loved one in a nursing home, or going to a nursing home soon, completing this form and meeting with us can save you a lot of money and grief.

With that said, here are some tips: I would recommend that before you start, you (1) Set aside an hour of un-interrupted time, (2) Get 3 months bank statements for *each of* Mom or Dad’s accounts; (3) Grab a cup of coffee and a calculator, pull up to the kitchen table and start. When you finish, just hit ‘Submit’ and the form will be securely transmitted to us. After we receive it, we will call you to set a time for a Free 60 minute initial consultation.

At the consultation, bring the bank statements, copy of property deeds and copies of any of Mom or Dad’s estate planning documents. Also bring any and all siblings and if there is a well parent, bring them as well. If you are doing this for your spouse, bring any adult children with you to help process information and ask questions. If you have a child out of state, let’s arrange a time where we can conference them in by phone.

Thanks for taking the time to thoroughly complete this form. If will save time for both of us and will help us be able to more accurately answer your questions. Again, as soon as we receive the completed form, we will contact the Contact Person listed on the form to set a time for your Free Initial Consultation.

Thanks,
Douglas R. Jones[/vc_column_text][vc_empty_space height=”20px”][vc_raw_html]JTNDYSUyMGNsYXNzJTNEJTIyd3BiX2J1dHRvbl9hJTIwdmFyaW91cyUyMiUyMGRhdGEtZmFuY3lib3gtdHlwZSUzRCUyMmlmcmFtZSUyMiUyMGhyZWYlM0QlMjJodHRwJTNBJTJGJTJGYXJrZWxkZXJsYXcuY29tJTJGZm9ybSUyRmluZGV4LnBocCUyMiUyMHRhcmdldCUzRCUyMl9ibGFuayUyMiUzRSUzQ3NwYW4lMjBjbGFzcyUzRCUyMndwYl9idXR0b24lMjAlMjB3cGJfYnRuLXN1Y2Nlc3MlMjB3cGJfYnRuLWxhcmdlJTIwZ3JlZW5wbGFubmluZ2J1dHRvbiUyMiUzRUNsaWNrJTIwaGVyZSUyMHRvJTIwY29tcGxldGUlMjBmb3JtJTNDJTJGc3BhbiUzRSUzQyUyRmElM0U=[/vc_raw_html][/vc_column][/vc_row]