HISHAW LAW LLC.

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

Welcome to Our Online Power of Attorney Service! For just $350, you can have your custom legal plan ready, quickly and securely. The process is quick and seamless, taking only about 10 minutes to complete. Simply to start, click "Next" to go through the questions, and once finished, our office will contact you to schedule a convenient time to meet with an Attorney . You'll also be registered with a login and password, allowing you to return and update your answers anytime.

First Name *

Middle Name

Last Name *

Email *

Password *

Phone Number *

Your Contact Details
Your Contact Details

Name:

Date Of Birth *

Also known as (optional)

Suffix (optional)

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Jr

✓

Sr

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II

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III

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Other

Select your gender? *

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Male

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Female

Please select "Select your gender?".

Your Address

Full Address: *

State

Your Contact Details Continued
Your Contact Details

Name:

Are you married? *

✓

Yes

✓

No

Please select "Are you married?".

Suffix (optional)

✓

Jr

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Sr

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II

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III

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Other

Please Name your parents (First & Last Name)

Full Name your mother:

Full Name your Father:

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 *

Date Of Birth *

Phone Number *

Suffix (optional)

✓

Jr

✓

Sr

✓

II

✓

III

✓

Other

Also known as (optional)

What is your spouse's gender? *

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Male

✓

Female

Please select "What is your spouse's gender?".

Is Your spouse's address different than you? *

✓

Yes

✓

No

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.

Provide the information of one or more individuals who will serve as your agent under the Durable Power of Attorney:

Primary Agent: *

Phone Number *

Email Address *

Alternative Agent * Click the "+" button to add another agent

Phone Number *

Email Address *

Alternative Agent *

Phone Number *

Email Address *

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.

Provide the information of individuals who will serve as your agent under the Durable Power of Attorney:

Do you want to use the same agents as your personal representative? *

✓

Yes

✓

No

Primary Agent: *

Phone Number *

Email Address *

Alternative Agent *

Phone Number *

Email Address *

Alternative Agent * Click the "+" button to add another agent

Phone Number *

Email 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

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

Do you wish to use the same agents as your Executor *

✓

Yes

✓

No

Primary Agent: *

Phone Number *

Address

Alternative Agent: *

Phone Number *

Address *

Alternative Agent: * Click the "+" button to add another agent

Phone Number *

Address *

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 individuals who will serve as your health care agent:

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

✓

Yes

✓

No

Primary Agent: *

Phone Number *

Address

Alternative Agent: *

Phone Number *

Address *

Alternative Agent: * Click the "+" button to add another agent

Phone Number *

Address *

HIPAA Agents
Under federal law, the Health Insurance Portability and Accountability Act (HIPAA) prohibits your medical providers from disclosing your medical information to anyone other than you or individuals you have specifically authorized.

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

Do you wish to use the same agents as your Medical Health Care Power of Attorney? *

✓

Yes

✓

No

Primary Agent : Full Legal Name: *

Phone Number

Address

Alternative Agent *

Phone

Address

Alternative Agent * Click the "+" button to add another agent

Phone *

Address *

HIPAA Agents Spouse/Partner
Under federal law, the Health Insurance Portability and Accountability Act (HIPAA) prohibits your medical providers from disclosing your medical information to anyone other than you or individuals you have specifically authorized.

Please provide the information of individuals who will serve as your hipaa agent:

Do you wish to use the same agents as your Medical Health Care Power of Attorney? *

✓

Yes

✓

No

Primary Agent : Full Legal Name: *

Phone Number

Address

Alternative Agent *

Phone

Address

Alternative Agent * Click the "+" button to add another agent

Phone *

Address *

Summary
Summary

If you would like to review your responses, please review your responses on the right hand side on the specific screens. After you click submit, you will be finished and we will email your answer and the office will contact you with the next steps .

Your Progress