Estate FB FK Law Firm

Selected Plan: Power Of Attorney

Welcome and Registration
Please use your legal name as it appears on your license or government-issue ID

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
Your Contact Details

Name:

Are you married? *

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Yes

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Are both you and your spouse US citizens? *

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Yes

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Suffix (optional)

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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
Please use your legal name as it appears on your license or government-issue ID

Your spouse's Details

First Name: *

Middle Name

Last Name: *

Email *

Phone Number *

Suffix (optional)

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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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State:

Financial DPOA:
Name someone (agents) you trust to make financial decisions on your behalf in the event you are unable to do so yourself.

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) *

Would your Spouse/Life Partner like to have different Power of Attorney than you?

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Yes

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Financial DPOA-Spouse/Partner
Name someone (agents) you trust to make financial decisions on your behalf in the event you are unable to do so yourself.

Primary Agent: *

Phone Number *

Address *

Health Care POA
Name someone (agents) to make medical decisions on your behalf in the event that you are unable to make those decisions for yourself

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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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 *

Would your Spouse/Life Partner like to have different agents than you?

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Yes

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Health Care POA - Spouse/Partner
Name someone (agents) to make medical decisions on your behalf in the event that you are unable to make those decisions for yourself

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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Primary Agent: *

Phone Number *

Address *

HIPAA Agents
Federal law under the Health Information Portability and Accountability Act (HIPAA) prohibits your medical providers from disclosing medical information to anyone other than you or individuals you have authorized. Your documents will include a HIPAA Authorization authorizing your medical providers to communicate with your health care agents under your Health Care Power of Attorney. In addition, it will also authorize communication with your trustees and/or financial agents under your Durable Power of Attorney as your trustees and/or financial agents may encounter HIPAA issues when handling your health insurance or medical bills. In some instances, you may wish to add additional individuals to your HIPAA Authorization. For example, perhaps you have other family members that you would wish to be able to communicate with your health care providers about your situation even if they are not your health care decisionmaker

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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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
A Directive to Physician also known as “Living Will” is a general declaration regarding your end-of-life wishes if you are unable to communicate them yourself. In other words, if you treating physicians advise your Health Care Proxy Agent that there is nothing further they can do to help you recover, this would be your written declaration that you would not want any further extraordinary measures, having a Living Will take the pressure off of your Health Care Proxy Agent from having to make that decision for you.

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

Signing Your Documents
Texas law requires that certain parts of your health care documents be notarized and witnessed by two disinterested individuals. This means that the notary and two witness must not be an agent or beneficiary in your documents. If the documents are not signed properly, there is a risk that they will not be legally valid documents. To best assist you in making sure your documents are signed properly, we have designed two options that you can choose from to have your documents executed: Sign at our office You may choose to come to our office where our team will have all your documents printed and ready for your signatures. We provide the notary and two witnesses. All you have to do is schedule a time and come visit!

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

Engagement Letter
Thank you for submitting your information. In order to become a client of our firm, please scroll to review our Engagement Letter. You will be emailed an executed copy and will be directed to our payment portal.

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