Metaverse Justice Group - Conservatorship Intake - Questionnaire

Welcome To The Metaverse Justice Group Conservatorship Intake

Thank you for placing your trust in our firm during this important time. We understand that navigating the conservatorship process can feel overwhelming, and our team is here to help make the process as clear and manageable as possible.
Please complete this secure intake form so we can gather the information needed to assist you. The form should take approximately 15–20 minutes to complete. You may save your progress and return at any time.
After submission, our team will review your information and follow up with the next steps or any additional information that may be needed.
Let’s begin with your information below.

Answer every question. If something does not apply, write "None" or "N/A." If you are unsure, give your best estimate and say so. Your attorney will review everything with you before anything is filed.

Petitioner's Personal and Family Data

First Name *

Middle Name

Last Name *

Email *

Password *

Cell Telephone *

Is petitioner a California resident? *

Yes No

Full Address *

Relationship to proposed conservatee *

If petitioner is the proposed conservatee's spouse, is petitioner a party to legal separation, dissolution, or annulment, or adjudication of nullity of marriage proceeding?

Yes No

If petitioner is the proposed conservatee's domestic partner, has petitioner terminated the domestic partnership or does petitioner intend to do so?

Yes No

If petitioner is the proposed conservatee's domestic partner, is petitioner a party to legal separation, dissolution, or annulment, or adjudication of nullity of marriage proceeding?

Yes No

Is petitioner a creditor? (Does the proposed conservatee owe petitioner money?) *

Yes No

Is petitioner a debtor of the proposed conservatee? (Does petitioner owe the proposed conservatee money?) *

Yes No

Petitioner's email address: *

Will anyone else join as a co-petitioner (for example, the other parent)? *

Yes No

Co-petitioner Relationship

Petitioner's preferred language, and is an interpreter needed?

Will petitioner be represented by an attorney, or file as a self-represented petitioner?

Proposed Conservatee's Personal and Family Data

Name (and all variations used): *

Proposed conservatee's telephone number: * (write "None" if none)

Date Of Birth *

Social Security Number *

Address during the past 5 years *

Permanent address if different from that given above:

Person: the conservator handles personal care (where the person lives, health care, food, safety). Estate: the conservator manages money and property and must report to the court. Both: the conservator handles everything.

Is the conservatorship for the Person, Estate, or Both? *

Can the proposed conservatee continue to live at their current residence? *

Yes No

Is the proposed conservatee currently a patient in, or on leave of absence from, a California state institution? *

Yes No

Is the proposed conservatee receiving benefits from the Department of Veterans Affairs (VA)? *

Yes No

A condition such as autism, intellectual disability, cerebral palsy, or epilepsy that began before age 18. If yes, the case is usually a "limited conservatorship," where the conservator receives only the specific powers the person needs.

Is proposed conservatee developmentally disabled? *

Yes No

Are they able to complete an affidavit of voter registration? *

Yes No

The person is expected to attend the court hearing. If they cannot for medical reasons, a doctor will need to sign a form explaining why.

Are they able to attend the hearing? *

Yes No

Marital Status

County where the proposed conservatee lives and how long they have lived there. Is the proposed conservatee a California resident? If the case will be filed in a different county, explain why: *

Does the proposed conservatee currently have a conservator, or has a conservatorship, guardianship or similar case ever been filed for them in California, another state, or a tribal court? *

Yes No

Is the proposed conservatee a member of a federally recognized Indian tribe? *

Yes No

Does the proposed conservatee wish to contest the conservatorship, object to the proposed conservator, or prefer that someone else act as conservator? *

Yes No

Is the proposed conservatee voluntarily requesting a conservator? *

Yes No

Is the proposed conservatee an adherent of a religion that relies on prayer alone for healing? *

Yes No

Primary language, and how the proposed conservatee communicates (speech, sign language, device, gestures).

Is an interpreter or accommodation needed for the court investigator visit or the hearing? *

Yes No

The court must consider less restrictive options first, such as a supported decision-making agreement, power of attorney, health care directive, or representative payee. Explain what you tried and why it is not enough.

What less restrictive alternatives to a conservatorship were considered (for example, supported decision-making agreement, power of attorney, advance health care directive, Social Security representative payee, trust, education-rights designation) and why are they not enough? *

Supported decision-making agreement – why not available or suitable: *

Designation of a health care surrogate – why not available or suitable: *

Advance health care directive – why not available or suitable: *

Power of attorney – why not available or suitable: *

Trust – why not available or suitable: *

Other alternatives – why not available or suitable: *

Benefits the proposed conservatee receives or will apply for (SSI, Medi-Cal, IHSS, regional center services, other):

Information Required to Identify Persons Entitled to Notice and to Give Notice of Hearing

Name of proposed conservatee's spouse or domestic partner *

Address of proposed conservatee's spouse or domestic partner *

List the person’s parents, grandparents, brothers and sisters, children, and grandchildren, each with their own home address. Write "deceased" if someone has passed away. These relatives receive notice of the case by mail.

Names, addresses, and relationships of relatives within second degree (children, parents, grandchildren, grandparents, brothers, sisters):

Names *

Relationship *

Address *

If no spouse, domestic partner, or second-degree relatives, provide the names, addresses, and relationships of the following:

Does the conservatee have a Spouse or domestic partner of predeceased parent of proposed conservatee?

Yes No

Children of predeceased spouse of proposed conservatee:

Conservatee’s spouse or registered domestic partner Phone Number

Conservatee’s spouse or registered domestic partner Address

Siblings of proposed conservatee's parents, and if none, children of proposed conservatee's parents' siblings:

Children of proposed conservatee's siblings:

What were the efforts made to find the proposed Conservatee’s relatives? *

Conservatee’s spouse or registered domestic partner;

Relatives within the first degree (adult children and parents); *

Relatives within the second degree (grandparents, adult grandchildren, sisters, and brothers); *

Relatives pursuant to Probate Code §1821(b) if there are no spouse or domestic partner of proposed Conservatee or relatives within the second degree known to Petitioner;

Names and telephone numbers (home, work, cell) of neighbors who are familiar with the proposed Conservatee’s situation; and

Names and telephone numbers (home, work, cell) of friends who may be able to assist the Court Investigator in understanding the proposed Conservatee’s situation.

Anyone else who should receive notice of the case who is not listed above (for example, a parent not listed, a caregiver, or a care facility). Give name, relationship and full address:

Information for the Confidential Supplemental Information Form

Does the proposed Conservatee accept informal or formal assistance voluntarily? *

Yes No

Did the proposed Conservatee ever execute a limited, general, or durable power of attorney for health care and/or estate management? *

Yes No

What health services were provided to the proposed Conservatee during the past 12 months? If so, describe. *

Were any social services provided in the past 12 months? If so, describe. *

Any estate management assistance rendered in the past 12 months? If so, describe. *

What diagnosis has the proposed Conservatee’s physicians given for their present disability? How long have they been disabled? *

Give specific, real examples. Instead of "needs help," write "cannot use the stove safely and has left burners on.

What are specific examples from the proposed Conservatee’s daily life showing significant behavior patterns indicating that they are unable to provide properly for their needs for physical health, food, clothing, and shelter?

Can the proposed Conservatee bathe, groom, and dress without assistance? *

Yes No

What is their physical condition? Are they bedridden or in a wheelchair? Can they walk unassisted? *

Do they cook for themselves? Shop for food and clothing by themselves? *

Yes No

Have there been recent medical crises? Have they fallen recently or been hospitalized? *

Yes No

What is the proposed Conservatee’s mental condition?

Are they forgetful? If yes, describe the consequences of the forgetfulness. *

Are they delusional or suffering from hallucinations? If yes, describe the consequences of these problems. *

Yes No

Do they recognize familiar people, places, and things? *

Are they alert and oriented to person, place, and time? *

Do they recognize their physical needs? Can they communicate these needs to others who can meet those needs? *

If the proposed Conservatee lives at home, what is the condition of the residence? Are there trip-and-fall hazards? Do the appliances work? *

Do other people live with the proposed Conservatee? If so, do they help or take advantage of them? *

Give specific, real examples. Instead of "needs help," write "cannot use the stove safely and has left burners on.

What are specific examples from the proposed Conservatee’s daily life showing significant behavior patterns that indicate that they are unable to manage their financial resources or to resist fraud or undue influence?

Does the proposed Conservatee pay their own bills? Have they received notice of nonpayment of utilities? Do they bounce checks? Forget to pay bills?

Have they made imprudent gifts or purchases?

Are they easily influenced by others? If so, give examples.

What are the circumstances that require the issuance of a temporary conservatorship of the person (if applicable)?

The person must be handed the court papers in person at least 15 days before the hearing, by an adult who is not the petitioner (a friend, relative, or process server).

Who will serve a Notice of Hearing (temporary conservatorship) and Citation (general conservatorship) with the Petition(s) on the proposed Conservatee (name, address, and telephone number)? *

Where can the proposed conservatee be personally served with the Citation, and what days/times are best? (Service must be made by an adult other than the petitioner – confirm process with attorney.) *

Who should the court investigator contact to schedule the home visit (name, phone)? Any safety or access considerations for the visit? *

Who provides daily care now (family, paid caregivers, IHSS provider), and during what hours? *

Current medications and what each is for; note any psychotropic medications:

Is a temporary conservatorship needed before the general hearing? (Yes/No – if Yes, complete Section 13.) *

Yes No

Does the proposed conservatee know about this petition? What is their reaction or opinion about the conservatorship and the proposed conservator? *

For your answers in Sections 2 and 4 (residence, personal needs, finances, services, alternatives, and the proposed conservatee's opinion), is your information based on personal knowledge, or on information and belief (what others told you)? If any answer is based on information and belief, identify which and the source. *

Capacity Declaration Information

A licensed physician or psychologist who knows the person and is willing to complete a court form about their ability to make decisions.

Name and license type of the physician or licensed psychologist who will complete the Capacity Declaration (GC-335), and has that provider agreed to complete it? *

Date of the proposed conservatee's most recent exam by that provider: *

Is authority to consent to medical treatment being requested because the proposed conservatee cannot give informed consent to any form of medical treatment? *

Is a medical practitioner or accredited religious practitioner prepared to state that the proposed conservatee cannot attend the hearing for medical reasons?

Treating specialists (neurologist, psychiatrist, developmental pediatrician, etc.) with names, addresses and phone numbers:

Physicians' names, addresses, and telephone numbers: *

Are dementia powers requested?

Yes No

Value of Conservator’s Estate

Complete only if Estate or Both was selected. Keep value (what something is worth today) separate from income (what it pays per year).

Character and estimated value of property of the conservatorship estate (for Petition and for purposes of calculating amount of the conservatorship bond):

The estimated value of the proposed Conservatee’s personal property:

Their probable annual gross income from:

Real property:

Personal property:

Pensions, if any:

Wages, if any:

Public assistance benefits:

Social Security payments:

Other income (child support, trust distributions, etc.):

Estimated value of any real property:

A bond is like insurance that protects the person’s money if it is mismanaged. It is usually required for an Estate case, based on the person’s assets plus about a year of income, and paid from the person’s funds. Not required for Person-only cases.

Bond: is a bond waiver requested, or will funds be placed in a blocked account? If blocked account, name and location of the institution:

If a bond waiver is requested, why? (for example, the estate is small and consists solely of public benefits). Note: the reason should be consistent with the values entered in item 6.

Documents and Other Information

Bank and savings and loan association accounts, name and address of institution or branch:

Real property (bring deeds if available, otherwise addresses):

Securities (a copy of a statement from each brokerage account):

Pension and retirement plans:

Tangible personal property, e.g., jewelry, paintings, cars, household furniture:

Insurance policies, e.g., life, health, disability, auto:

Business interests (partnership agreements, shareholder agreements, bylaws, etc.):

Property located outside California (deeds if available, otherwise addresses):

Other property, e.g., royalties, mineral interests, accounts or notes receivable:

Jointly held property and Totten trusts. Give special attention to how it will be managed and whether it should be used first or last in supporting the conservatee:

Trusts of which proposed conservatee is beneficiary:

Additional assets:

Safe-deposit boxes. Give name and address of institution and box number; also, location of safe-deposit keys and name and address of any other person having access; describe contents:

Name, address, and description of claim by others to property held by proposed conservatee. Is claim admitted?

Description of claim by proposed conservatee to property held by another, including name and address of third party, description of property, and nature of claim:

Is proposed conservatee a party to any contracts? Name and address of other parties to contract, nature of contract, and copy, if available:

Debts. Names and addresses of creditors, amount of indebtedness, nature of debts, and whether liability is admitted or disputed:

What are proposed conservatee's testamentary plans? Names and addresses of persons who assisted in planning:

Has proposed conservatee made a will? Is a copy available? If so, from whom? Who are the beneficiaries?

Yes No

Is proposed conservatee the settlor or trustee of any trust? *

Yes No

Does proposed conservatee have an attorney? *

Yes No

Upload any of the following: powers of attorney, advance health care directive, trust documents, deeds, account statements, insurance policies, any written nomination of conservator, diagnosis letters, IEP/IPP, regional center reports.

Proposed Conservator's Personal Data

Did the proposed Conservatee ever express a preference concerning the appointment of a Conservator? Obtain a copy of any written nomination. *

Name (how does the proposed conservator sign legal documents?): *

Address: *

Home phone number:

Work phone number:

Mobile phone number: *

Date of birth: *

Required on a confidential form the court uses for background checks. It is not part of the public court file.

Social Security number:

Required on a confidential form the court uses for background checks. It is not part of the public court file.

Driver's license state and number:

How long has the proposed Conservator known the proposed Conservatee (years and months)? *

Whether the proposed conservator is the proposed conservatee's spouse, and whether any divorce, dissolution, or marital separation proceedings have been commenced:

Is the proposed Conservator a professional fiduciary? If so, we will need their license number and the date the license was last renewed. *

If a professional fiduciary is the Petitioner, who engaged them?

What were the circumstances and manner of their engagement?

Before their engagement, what was the prior relationship between the professional fiduciary and the proposed Conservatee, their family, or their friends?

Proposed conservator's email address: *

Is there more than one proposed conservator (for example, both parents as co-conservators)? *

Will the same person serve as conservator of the person AND conservator of the estate? If not, identify each (repeat Sections 8 and 10 for each person).

Does the proposed conservator live with the proposed conservatee? If not, how far away?

Has the proposed conservator completed, or agreed to complete, the court-required education for non-professional conservators? *

Yes No

Proposed Conservator's Relation to Proposed Conservatee

Is the proposed conservator also the petitioner in the conservatorship proceeding? *

Yes No

Was the proposed conservator nominated, and if so, by whom? *

Proposed Conservator's Fitness to Act

Has proposed conservator filed for bankruptcy? *

Yes No

Has proposed conservator committed any crimes in the past, of any degree? *

Yes No

Are there powers under Probate Code section 2590 that the proposed Conservator would like to request? (See attachment)

Will the proposed Conservatee be adjudged to lack the capacity to give informed consent for medical treatment? *

Yes No

Will special orders regarding dementia powers be requested? *

Yes No

Has the proposed conservator ever been removed as a guardian, conservator, trustee or other fiduciary? *

Is the proposed conservator subject to any restraining order, or currently charged with any crime? *

Yes No

Limited Conservatorship (Developmental Disability)

For each power, check whether you need it and give a real example of why. The person keeps every right not granted to the conservator.

Fix the residence (decide where the conservatee lives):

Access the conservatee's confidential records and papers (medical, school, regional center):

Consent or withhold consent to marriage or registered domestic partnership:

Enter into contracts on the conservatee's behalf:

Give or withhold consent to medical treatment:

Make decisions about education:

Make decisions about social and sexual contacts and relationships:

Limited powers over the estate (finances), if any:

Manage the estate

Contract on behalf of the conservatee and the estate

Compromise and settle claims by or against the conservatee or estate

Invest estate assets

Sell estate assets

Pay the conservatee's debts and expenses

Borrow money, give security, lease, convey or exchange estate property

Should any other civil or legal rights of the conservatee be limited?

Yes No

Dementia Powers

Current or proposed placement (facility name and address) and whether it is a secured-perimeter facility:

Was the proposed conservator nominated, and if so, by whom?

Physician or licensed psychologist with at least two years' experience diagnosing major neurocognitive disorders who will complete GC-335A:

Temporary Conservatorship

Describe the urgent circumstances, with specific dates and events, that require a temporary conservator before the general hearing:

Powers needed on a temporary basis, and whether any change of residence is proposed during the temporary period:

Reference: Where Intake Answers Are Used

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