Estate Planning Client Intake Form (for spouses)

Date *

Referred ByIf applicable

Urgency? *YesNoPlease indicate if your matter is urgent

Reason for Urgency *E.g. terminal illness, impending travel, family litigation, etc.

Contact Information

Are you married or common-law? *MarriedCommon-law

Date of Marriage *

Date of Cohabitation *

Please indicate the approximate date you began cohabiting together

Location of Marriage *Please indicate the city and province where you were married

Street Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Country

Phone Number *Please indicate if this is a cell or landline

Fax

Email? *YesNo

Email Address *

Business Owner? *YesNoPlease indicate if either of you are self-employed/own a business

Business Information

Business Name *

Business Address *

Apartment, suite, etc

City *

Province *

Postal Code *

Country

Business Phone *

Business Fax

Business Email

Website

Personal Information - Spouse #1

Prefix

First Name *

Middle Name(s)

Last Name *

Date of Birth *

Occupation *If retired, please indicate most recent occupation (e.g. "Retired Welder")

Prior Marriages?

Personal Information - Spouse #2

Prefix

First Name *

Middle Name(s)

Last Name *

Date of Birth *

Occupation *If retired, please indicate most recent occupation (e.g. "Retired Welder")

Prior Marriages?

Family

Children/Grandchildren

Assets and Other Information

Other Assets

Do you own assets jointly with a person other than your spouse? *YesNo

Do you currently have a Will and/or Powers of Attorney? *YesNo

Do any of your beneficiaries have any disabilities or special needs? *YesNo

Do you take any medication that affects your mood or cognitive ability? *YesNo

Medications *

Additional Information