Consultation questionnaire

Information about you
Name*
First Middle Last
If you are not married, please put in your full name exactly as you wish it to appear in your estate documents. If you are married, please put in the husband’s name here as you wish it to appear in your estate documents. The next several fields should provide the husband’s contact details. The wife’s information will be requested later in the document.
Address*
Street Address Address Line 2 City State ZIP Code
County (not Country!)*
Phone*
Email
Date of birth
MM slash DD slash YYYY
Do you have any special needs, disabilities or serious medical conditions?
- Yes
- No
Please describe
Do you currently have any of the following documents (check all that apply)?
- Will
- Trust
- Medical / Health Care Power of Attorney
- General Durable Power of Attorney (“Financial Power of Attorney”)
- Advance Medical Directive / Health Care Directive (aka “Living Will”)
- Guardianship for minors
- I’m not sure

Wife's Information
Name
First Middle Last
Please provide the wife’s information exactly as you would like it to appear in the estate documents.
Phone
Email
Date of birth
MM slash DD slash YYYY
Does your spouse have any special needs, disabilities or serious medical conditions?
- Yes
- No
Please describe
Does your spouse currently have any of the following documents (check all that apply)?
- Will
- Trust
- Medical / Health Care Power of Attorney
- General Durable Power of Attorney (“Financial Power of Attorney”)
- Advance Medical Directive / Health Care Directive (aka “Living Will”)
- Guardianship for minors
- I’m not sure

Information about your children
Please identify for each child:*
Full Name (First, Middle, Last) Date of birth Any special needs or disabilities?

Click on the “+” button to add additional rows

Financial Information
This information allows The Ala Firm to make recommendations specific to your family’s needs.
Estimate your family's net worth (assets minus debts):
- Under $500,000
- $500,000 to $1,000,000
- $1,000,000 to $2.2M
- $2.2M or above
Which of the following statements best describes how you and your spouse manage your assets:
- We combine most of our assets
- We combine some assets and hold some assets separately
- We hold most of our assets separately
Do you have a pre-nuptial agreement?
- Yes
- No
Do you own your primary residence?
- Yes
- No
(Select yes even if you have a mortgage)
Who is identified as the owner on the deed?
Do you own any other real property?
- Yes
- No
For each property, please state:
Type of property (rental home, land, etc.) Full Address Who owns the property? Is there a mortgage?
Do you have a 401k, IRA or other pre-tax retirement plan?
- Yes
- No
Does your spouse have a 401k, IRA or other pre-tax retirement plan?
- Yes
- No
Do you have stocks, bonds or other equities held in a non-retirement account?
- Yes
- No
Does your spouse have stocks, bonds or other equities held in a non-retirement account?
- Yes
- No
Do you have life insurance?
- Yes
- No
Does your spouse have life insurance?
- Yes
- No
Are you currently receiving social security benefits?
- Yes
- No
Do you or your spouse currently receive social security benefits?
- Yes
- No
Do you own any part of a business (such as a sole proprietorship, LLC or partnership)?
- Yes
- No
Describe the type of business
Do you or your spouse own any part of a business (such as a sole proprietorship, LLC or partnership)?
- Yes
- No
Describe the type of business
Do you own any valuables such as jewelry, artwork, antiques, guns, collectible cars, other collectibles or any other asset that you wish to include in your estate plan?
- Yes
- No
Please describe
Do you wish to plan for charitable giving as part of your estate plan?
- Yes
- No
Please describe

Consultation questionnaire

General Questionnaire

Step 1 of 6

Information about you

Family Information

Wife's Information

Information about your children

Financial Information

Other Information

Full Name (First, Middle, Last)	Date of birth	Any special needs or disabilities?

Type of property (rental home, land, etc.)	Full Address	Who owns the property?	Is there a mortgage?