Get Yor Free Case Analysis Fill inFree online case analysis – personalized to your needsPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 14Free AssessmentClick to get started!Get Started!To create your report, we need to know the name of the person needing care.First Name *Last Name *Click the angle arrow to go to the next question.‹›Their monthly incomeTell us the total monthly income of the individual.Monthly Income of the Person Needing Care *Click the angle arrow to go to the next question.‹›What is this person's marital status? *MarriedWidowedDivorcedNever MarriedClick the angle arrow to go to the next question.‹›Spouse's InformationIf the person in care is married, please give us their spouse's name.Spouse's First Name *Spouse's Last Name *Spouse's Monthly IncomeEnter the monthly income of the spouse here.Spouse's Monthly Income *Financial Accountsif you don’t have an account put 0 Be sure to put account totals in the right category. For instance, IRAs/401(k)s are treated differently than bank accounts, CDs, and other investments. List the total Balances in all bank accounts:Add up all of these types of accounts for BOTH spouses, if married.List total of all CDs *Add up all of these types of accounts for BOTH spouses, if married. Do NOT enter Retirement Account CDs here, they go in the next block.List Total of Annuities *Input the total of all annuities for both spouses here. Do NOT list IRA Annuities here, only non-qualified annuities. IRA Annuities should be counted in the next blocks for retirement funds.Total Amounts in Retirement accounts (IRAs, 401(k)s, IRA/Qualified Annuities, etc.) for the Person in Care: *Add up all retirement accounts belonging to the person in care in this block.Total Amounts in Retirement accounts (IRAs, 401(k)s, IRA/Qualified Annuities, etc.) for the Spouse (if married)Add up all retirement accounts belonging to the Spouse in this block. *ENTER $0.00 IF UNMARRIEDClick the angle arrow to go to the next question.‹›Financial Accountsif you don’t have an account put 0 Be sure to put account totals in the right category. For instance, IRAs/401(k)s are treated differently than bank accounts, CDs, and other investments. List the total Balances in all bank accounts: *Add up all of these types of accounts for BOTH spouses, if married.List total of all CDs *Add up all of these types of accounts for BOTH spouses, if married. Do NOT enter Retirement Account CDs here, they go in the next block.List Total of Annuities *Input the total of all annuities for both spouses here. Do NOT list IRA Annuities here, only non-qualified annuities. IRA Annuities should be counted in the next blocks for retirement funds.Total Amounts in Retirement accounts (IRAs, 401(k)s, IRA/Qualified Annuities, etc.) for the Person in Care *Add up all retirement accounts belonging to the person in care in this block.Total Amounts in Retirement accounts (IRAs, 401(k)s, IRA/Qualified Annuities, etc.) for the Spouse (if married) *Add up all retirement accounts belonging to the Spouse in this block. *ENTER $0.00 IF UNMARRIED‹›Real Property: Homes & LandProperty AddressCo-Owner(s) (if any)Primary Residence (Check if Yes)Yes Click the angle arrow to go to the next question.‹› Do you have life insurance, If none, please enter 0Face Values / Death Benefit of ALL Policies *Cash Surrender Values of ALL Policies *Click the angle arrow to go to the next question.‹›Nursing home costs – if applicableWhat is the monthly cost of the nursing home? *If none, please enter 0Click the angle arrow to go to the next question.‹›Disabled ChildrenDisabled children or special needs *YesNoLeave a noteClick the angle arrow to go to the next question.‹›Children InformationPlease list all children and their ages. Include any children from prior marriages or relationships.Child's NameAgeFrom Prior Marriage/RelationshipYes Click the angle arrow to go to the next question.‹›Do you want to disinherit any specific individuals, if so please explainClick the angle arrow to go to the next question.‹›Any specific notes or intentions you want the attorney to know before creating your reportClick the angle arrow to go to the next question.‹›Fill in your personal detailsIn order to email you the results we will need your contact information.First Name *Last Name *Email *Phone *Address *City *State *SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code *Consent to us contacting you electronically by email or by phone* *Consent to us contacting you electronically by email or by phone*Submit
