Welcome To Lexaguard Digital Intake
Please use your legal name as it appears on your license or government-issue ID
Get started, provide your information below and provide your Child's info on the next page

Have you met with our office before? *
✓
Yes
✓
No
Applicant Information
Please let our office know if you are completing this intake for yourself or a loved one. If for a loved one, please indicate your relationship to the applicant. By providing our office with information regarding any health issues, it helps us to get an understanding of what care may be needed in the future or possible benefits you may be eligible to receive. If you are interested in special needs planning, please do not complete this intake with information for the child or beneficiary with a special need. The person that would like to set up planning for the person with a special need should complete this section. There will be a section to add information on the person with a special needs later in this intake.
Are you filling this out for yourself or for your loved one? *
✓
For a Loved One
✓
For Myself
Do you have any health issues? *
✓
Yes
✓
No
Are you/the applicant currently in a rehab, hospital or nursing home? *
✓
Yes
✓
No

General Information
Please answer yes or no to the questions on this page.
Are you/the applicant a veteran? *
✓
Yes
✓
No
Do you/the applicant have any estate planning documents (Will, POAs, Trusts)?
✓
Yes
✓
No
Do you/the applicant have any children? *
✓
Yes
✓
No
Information
If you are completing this form for yourself, please enter your information and, if applicable, your spouse’s information. If you are completing this form for a loved one, please enter their information and spouse’s, if applicable, and your information.
Applicant Information
*

*

*

*

*

*

Is the applicant married? *
✓
Yes
✓
No
Suffix(optional)
✓
Jr
✓
Sr
✓
II
✓
III
✓
Other
What are your personal pronouns?
✓
he/him
✓
she/her
✓
they/them
*

Is Your mailing address the same as your home address? *
✓
Yes
✓
No
Total Estate Size
When determining your total estate size, please include the approximate value of any real estate, bank accounts, investment accounts, retirement accounts, businesses, and other assets. Please do not include the death benefit of any life insurance. If you do not know this information, please select your best estimate. This information is only used to match you with the best team for your estate planning. We do request more specific asset information on the following pages. It is recommended that you add this additional asset information, but it is not required. By providing this additional information now, we can ensure your time spent speaking with our office during your appointment is as productive as possible.
*
Real Estate
Please provide information regarding the assets you own. This information helps our firm to understand the size of your estate, where your assets are held, debts you may owe, and any business interests. All these factors affect the planning and recommendations that our firm provides for you. It is important to provide as much information as possible. If you do not know exact figures, please enter your best estimate or “unknown.” If you are not sure of any asset information, please make a note at the end of this form and we can discuss further during your first appointment.
Do you/the applicant own a home?
✓
Yes
✓
No
Assets Information
Please provide information regarding the assets you own. This information helps our firm to understand the size of your estate, where your assets are held, debts you may owe, and any business interests. All these factors affect the planning and recommendations that our firm provides for you. It is important to provide as much information as possible. If you do not know exact figures, please enter your best estimate or “unknown.” If you are not sure of any asset information, please make a note at the end of this form and we can discuss further during your first appointment.
Do you/the applicant own any checking or savings accounts? *
✓
Yes
✓
No
Do you/the applicant own any retirement accounts? *
✓
Yes
✓
No
Do you/the applicant have any outstanding debt besides a mortgage? *
✓
Yes
✓
No
Assets Information Continued
Please provide information regarding the assets you own. This information helps our firm to understand the size of your estate, where your assets are held, debts you may owe, and any business interests. All these factors affect the planning and recommendations that our firm provides for you. It is important to provide as much information as possible. If you do not know exact figures, please enter your best estimate or “unknown.” If you are not sure of any asset information, please make a note at the end of this form and we can discuss further during your first appointment.
Do you/the applicant own any investment or non-retirement accounts? *
✓
Yes
✓
No
Do you/the applicant own a business? *
✓
Yes
✓
No
Do you/the applicant own any life insurance policies? *
✓
Yes
✓
No
Do you work with a financial advisor? *
✓
Yes
✓
No
Do you have any additional information to share or comments that would be helpful to know about your assets? *
✓
Yes
✓
No
Monthly Income
Please provide your monthly income information on this page. By knowing your monthly income, it helps our firm know what types of benefits you may be eligible for.
Please add your/the applicant’s income information for any applicable sources.

Currently Employed?
✓
Yes
✓
No

Is your spouse currently Employed?
✓
Yes
✓
No
Additional Information

Referral Information
We are so happy you found us, and we would like to know where you learned about our firm. This information helps us to ensure we are marketing in the correct areas and thanking our referrals. All client information is kept confidential when sending thank you notes.
How did you learn about Beacon Legacy Group?
*

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 .
Preview Answer
Your Progress

0% Complete

Welcome To Lexaguard Digital Intake Applicant Information General Information Information Total Estate Size Real Estate Assets Information Assets Information Continued Monthly Income Additional Information Referral Information Summary