Welcome to Miller Law Office,PLLC Elder Law Estate Planning
Digital Intake Information
Thank you for visiting our Digital Intake.

Please fill out the intake application to provide your finacial information and assesment. Upon completion, you can schedule a time with our office and complete your Estate Plan.

Applicant Information
If you are married, your spouse will be automatically selected as your primary agent throughout this interview. Please know that you are not required to have your spouse as your primary agent and you may choose to have another individual act as your primary helper.
Are you married? *
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Yes
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No
Please select "Are you married?".
About You
Your full legal name is required for your estate planning documents. This would be the name you are referred to on your driver’s license, social security card, passport or other federal government ID. Do not forget to add your full middle name if you have one. If your driver’s license, social security card, passport, or other forms of identification do not match, use the full name indicated on your driver’s license and list the other names in the “also known as” field.
Your full legal name is required for your estate planning documents. This would be the name you are referred to on your driver’s license, social security card, passport or other federal government ID. Do not forget to add your full middle name if you have one. If your driver’s license, social security card, passport, or other forms of identification do not match, use the full name indicated on your driver’s license and list the other names in the “also known as” field.
Is US Citizen? *
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Yes
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No
Are you a veteran?
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Yes
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No
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Is this your first marriage? *
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Yes
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No
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Do you have any children?
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Yes
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No
Signing Documents
Signing Documents
Signing Documents
Do you have any existing documents already (Wills, Trusts, Financial Power of Attorneys, Living Will, Medical Power of Attorney)? *
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Yes
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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.
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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?
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Yes
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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.
Does the client own Non-retirement accounts such as investment/ annuities /stocks/ bonds/ mutual funds? *
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Yes
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No
Does the client have Businesses? *
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Yes
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No
Does the client own Cash/Saving/CD's Accounts? *
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Yes
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No
Does the client own Retirement Accounts? *
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Yes
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No
Does the client own personal property? *
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Yes
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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? *
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Yes
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No
Do you/the applicant own a business? *
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Yes
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No
Do you/the applicant own any life insurance policies? *
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Yes
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No
Do you work with a financial advisor? *
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Yes
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No
Do you have any additional information to share or comments that would be helpful to know about your assets? *
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Yes
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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?
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Yes
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No

Is your spouse currently Employed?
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Yes
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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 Mayhone Elder Law?
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Welcome to Miller Law Office,PLLC Elder Law Estate Planning Applicant Information About You Signing Documents Total Estate Size Real Estate Assets Information Assets Information Continued Monthly Income Additional Information Referral Information Submission Screen