Neyens Law PLLC,

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Legacy Wealth Planning Consultation Form

Pre Consultation Form CP

1Your Information

2Children

3Additional Information

Your Information
First Name *(Required)
Last Name(Required)
Marital Status(Required)
- Married
- Unmarried
Email Address(Required)
Date of Birth *
MM slash DD slash YYYY
Client Gender
Spouse/Partner Information
Spouse/Partner’s First Name
Spouse/Partner’s Last Name
Spouse’s Email Address
Spouse/Partner’s Date of Birth
MM slash DD slash YYYY
Spouse Gender
Physical Address
Physical address line 1
Physical address line 2
Physical address city
Physical State
Physical address zip/postal code
Is your Mailing Address the same as Physical Address?
- My Mailing Address is the same
- My Mailing Address is different. I'd like to enter that address
Mailing Address
Mailing address line 1
Mailing address line 2
Mailing address city
Mailing State
State
Mailing address zip/postal code
Phone Number 1
Phone Number 1 Description
Phone 1 number
Add A Second Number
- Add Another Phone Number
Phone Number 2
Phone Number 2 Description
Phone 2 number
Add A Third Number
- Add Another Phone Number
Phone Number 3
Phone Number 3 Description
Phone 3 number

My estate has the following assets:
- Business/Partnerships
- Certificates of Deposit
- IRA/Retirement Plans
- Life Insurance
- Real Estate
- Stocks, Bonds, Mutual Funds
- Other
Please check one of the following boxes:
- I am ready to proceed with the creation of my plan.
- My loved one is already in a nursing home, I am ready to proceed with a plan.
- I am not interested in creating a plan at this time. I’m here for general information only.
- I need the following questions answered before I am ready to proceed with the creation of my plan:
Enter Additional Questions
Approximate gross value of my estate
I have concerns about a Special Needs family member:
- Yes
- No
What Really Matters to Me
Please rate the following estate planning goals and concerns on a scale of 1 to 10. (1 being “not important at all” and 10 being “very important.”)
Please rate the following estate planning goals and concerns on a scale of 1 to 10. (1 being “not important at all” and 10 being “very important.”)
Make sure there’s a written plan to handle my affairs
Please enter a number from 1 to 10.
Make sure Nursing Home costs don’t use up all my assets
Please enter a number from 1 to 10.
Make sure my wishes are honored regarding life support decisions
Please enter a number from 1 to 10.
I want to minimize all Death Taxes
Please enter a number from 1 to 10.
After my death, make sure my estate stays with my children if they get divorced
Please enter a number from 1 to 10.
Protect my life insurance from Death Taxes
Please enter a number from 1 to 10.
Protect my estate if my spouse gets remarried after my death
Please enter a number from 1 to 10.
After my death, protect my estate from my children’s creditors
Please enter a number from 1 to 10.
Protecting my special needs child after my death
Please enter a number from 1 to 10.
Funeral planning for my final arrangements and to make it easier for my family
Please enter a number from 1 to 10.

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Neyens Law PLLC,

Oakdale, MN (Main Office)
600 Inwood Ave N, Suite #150,

Oakdale, MN 55128

United States (US)

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Office Hours

Monday	9:00 AM - 5:00 PM
Tuesday	9:00 AM - 5:00 PM
Wednesday	9:00 AM - 5:00 PM
Thursday	9:00 AM - 5:00 PM
Friday	9:00 AM - 5:00 PM

By Appointment Only

December 23rd - 26TH we are CLOSED

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