Hook Law

Elder Law

"*" indicates required fields

To facilitate a comprehensive understanding of your family’s specific situation, we kindly request your cooperation in completing the questionnaire to the best of your ability. It is essential that this form be completed on behalf of the individual seeking our services. For instance, if you are reaching out on behalf of a parent(s) or someone in need of care, please ensure that you fill out the form on their behalf.

Please rest assured that the information you provide serves the exclusive purpose of enhancing your relationship with Hook Law and will be handled with the utmost privacy and confidentiality. Furthermore, your completed questionnaire will be submitted through a secure and encrypted channel to ensure the highest level of data protection.

Full Name with Middle Initial*
Address
MM slash DD slash YYYY

Spouse / Partner Information

Spouse/Partner Full Name with Middle Initial*
MM slash DD slash YYYY

Tell us about the family of the person requiring Hook Law’s services

What services are sought from Hook Law?*
Select all scenarios that apply to your situation
Select all scenarios that apply to your long term care situation
Select all scenarios that apply to your estate administration situation
Select all scenarios that apply to your trust administration situation
ie: Mother, Father, Child, Sibling, etc.
Children*
Click on the (+) to add more children. If they are still living at home, submit your phone number, email, and zipcode.
Child's Name
Phone
Email
Birthdate
Address and Zip
 
Grandchildren*
Click on the (+) to add more grandchildren
Child's Name
Phone
Email
Birthdate
Address and Zip
 
Type of pets (check all that apply)*

Assets

If a field does not apply, leave blank.

IF MARRIED include all individual and joint assets.

If you are working with us for an estate administration matter, list the assets of your deceased family member

If a field does not apply to you, leave blank.

If you are working with us for a guardianship matter, list the assets of your incapacitated family member

If a field does not apply to you, leave blank.

Real Estate
List all that apply. Leave “mortgage balance” blank if your real estate is not financed.

Click on the (+) to add more properties.

Address
Property Value
Mortgage Balance
 
Business Assets

Click on the (+) to add more businesses.

Business Name
Business Value
 
Automobile(s)
List all that apply. Leave “loan balance” blank if your car is not financed.

Click on the (+) to add more automobiles.

Year
Make
Model
Value
Loan Balance
 
Bank Accounts
Example Account Types: Checking, Savings, CD’s, Money Markets

Click on the (+) to add more bank accounts.

Bank Name
Account Type
Account Value
 
Investment Accounts
Example Account Types: Brokerage Accounts, Stocks, Bonds, IRA’s, Retirement Accounts, 401k, Annuities, etc.

Click on the (+) to add more investment accounts.

Bank/Broker Name
Account Type
Account Value
 
Unsecured Debt

Example Account Types: Credit Cards, Medical, Tax Liens, Student Loans, etc.

Click on the (+) to add more unsecured debts.

Lender
Account Type
Balance
 
Other Assets

Other assets may include art, collectibles, intellectual property, etc.

Click on the (+) to add more assets.

Type of Asset
Value
 
Life Insurance

Click on the (+) to add more life insurance policies.

*Type of policy – Term, Universal, Whole Life, or other. You may also type “unknown” if you are not sure.

Insurance Company
Type
Death Benefit
*Face Value
Cash Value
 
Other Insurance

Click on the (+) to add more insurance policies.

*Type of Policy – Long-Term Care, Disability, Umbrella, Personal Liability, etc.

Do not use this field to submit health insurance information.

Insurance Company
Type of Policy
 
If you have a scheduled appointment to meet with someone at the Hook Law, please fill in the date below. If you do not yet have an appointment, please leave this field blank.
MM slash DD slash YYYY

Long-Term Care Questions

Veterans Benefits

What type of benefits? (check all that apply)*

Health Insurance

Individual / Partner 1 Health Insurance (check all that apply)*
Health Insurance Company*
*Insurance types include Group, Individual, Supplemental, or other.
Insurance Company
Policy Number
Type of Coverage*
 
Spouse/Partner 2 Health Insurance (check all that apply)*
Health Insurance Company*
*Insurance types include Group, Individual, Supplemental, or other.
Insurance Company
Policy Number
Type of Coverage*
 
Monthly Income*
IMPORTANT: Click on the (+) to add spouse or partner’s monthly income.
Social Security
Pension
VA Disability
Investment
 
Other Income

IMPORTANT: Click on the (+) to add other monthly income sources

*Recipient – Type Wife, Husband, or yours or your partner’s name to indentify who is receiving the other income.

Income Source
Amount ($)
Recipient
 

Gift Tax

List all gifts below
Click on (+) to add more gifts. List all gifts greater than $1,000
Date
Amount ($)
Recipient
 

By submitting this form, I understand that the law firm and its individual lawyers will rely on this information when making recommendations.

YOU MUST CLICK SUBMIT TO COMPLETE THIS QUESTIONNAIRE

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