Estate FB FK Law Firm

Welcome and Registration

To get started, please provide your information below. This information will be used to generate your Power of Attorney documents.

Your privacy and security are important to us. Please Note: This site is database-driven and utilizes a secure, encrypted MySQL database to protect all data and passwords. We understand that you are providing sensitive information, and this application has been developed to meet industry-standard security requirements, including those used for PCI-protected environments. If you prefer not to enter certain information online, you may leave those fields blank. Once you hit “Submit,” you will have the opportunity to edit and adjust the generated Word document before finalizing it.

First Name *

Middle Name

Last Name *

Email *

Password *

Phone Number *

Your Contact Details

Name:

Date Of Birth *

Are you married? *

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Yes

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No

Suffix (optional)

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Jr

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Sr

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II

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III

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Other

Gender?

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Male

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Female

Your Address

Full Address: *

State

Zip Code

Your Spouse Information

Your spouse's Details

First Name: *

Middle Name

Last Name: *

Email *

Date Of Birth *

Phone Number *

Suffix(optional)

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Jr

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Sr

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II

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III

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Other

Also known as( optional)

Gender?

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Male

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Female

Is Your spouse's address different than you?

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Yes

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No

State:

Financial DPOA:

Name 3 people to serve as your agent under the Durable Power of Attorney.

(The DPOA allows the person you name as your agent to make financial and property related decisions for you. The power can become effective at the time you sign the DPOA or later only in the event of your incapacity. This choice will be made at the time you sign the document.)

Primary Agent Full Legal Name *

Phone Number *

Address (Please include City, State and Zip code) *

Alternate Agent Full Legal Name *

Phone Number *

Address (Please include City, State and Zip code) *

Second Alternate Agent Full Legal Name *

Phone Number *

Address (Please include City, State and Zip code) *

Financial DPOA-Spouse/Partner

Primary Agent: *

Phone Number *

Address *

Health Care POA

Name 3 people to serve as your agent under your Medical Power of Attorney.

(A Medical Power of Attorney allows an Agent to make medical decisions on your behalf in the event that you are unable to make those decisions for yourself. If you are married, your spouse will be named as your Agent. Please name at least one individual as an Alternate Agent.)

Do you wish to use same agents as your Financial Power of Attorney? *

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Yes

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No

Primary Agent Full Legal Name *

Phone Number *

Address *

Alternate Agent Full Legal Name *

Phone Number *

Address *

Second Alternate Agent Full Legal Name *

Phone Number *

Address *

Health Care POA - Spouse/Partner

Please provide the information of one or more individuals who will serve as your health care agent:

Do you wish to use the same agents as your Financial Power of Attorney?

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Yes

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No

Primary Agent: *

Phone Number *

Address *

HIPAA Agents

All of the persons named in your Durable Power of Attorney and Medical Power of Attorney will be listed in your HIPAA release.

Do you wish to add anyone else?

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Yes

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No

If you select “Yes,” an input field will appear at the bottom to add a new agent. If you wish to add more agents, click the “+” icon to add another agent.

Agent Name

Agent Address

Agent Phone Number

Directive to Physician

Your plan will include a Directive to Physicians document also known as Living Will.

Signing Your Documents

Please contact us to schedule the signing, this will be at our office.

Engagement Letter

Download

I acknowledge and accept the terms outlined in this engagement letter

Thank You & Next Steps!

Thank you for taking the time to answer these questions. If you’d like to review your responses before submitting, you can do so on the right-hand side of the specific screens. Once you click Submit, your answers will be finalized and automatically emailed to you.

The office will then contact you with the next steps. If you have any remaining questions or concerns, please don’t worry—simply write them down and bring them to your next meeting. Your attorney will review your responses and discuss them with you in greater detail during that meeting.

Your Progress