Pre-Appointment Questionnaire

This questionnaire MUST be submitted in order for you to schedule your CCP Annual Review Appointment.

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Your Name

First Middle Last Suffix

Mailing Address(Required)

This is to verify that we have the correct address on file.

Street Address City State ZIP Code

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Who do you nominate to act as your Supported Decision-Maker?

A Supported Decision-Maker is similar to you naming a trusted contact with a financial institution. By naming a trusted contact you give the financial institution permission to contact and discuss if they suspect financial exploitation or if they have concerns for your health and welfare.

Do you have any further changes to your Estate Plan?(Required)

If no further changes to your Estate Plan, select no and proceed to the Submit button at the bottom of this form.

Yes, I'll describe below.

No further changes. - STOP HERE and Submit form

Please note, only complete the fields below that apply to you.

Distribution

Do you have changes to the distribution of your Estate upon your passing?

Successor Trustees

Would you like to change who you have nominated to serve as your Successor Trustees?

Personal Representatives

Would you like to change who you have nominated to serve as your Personal Representative in your Last Will & Testament?

Power of Attorney

Would you like to change who you have nominated to serve as your Durable Power of Attorney?

Living Will

Would you like to change who you have nominated as your Surrogate?

Health Care Surrogate

Would you like to change who you have nominated as your Heath Care Surrogate?

HIPAA Release

Would you like to change who you have nominated in your HIPAA Release?

Disposition of Bodily Remains & Funeral Preference

Would you like to change your Disposition of Bodily Remains & Funeral Preference?

Questions, comments, concerns or other life changes not mentioned above?

This includes new assets, name changes, address changes, additional properties, acquisitions, etc.

Upload relevant files below.

Reminder do not to write on original documents. Hand write notes on a separate paper for us to make needed changes. Feel free to upload picture of notes here should you want to.

File

Max. file size: 100 MB.

Pre-Appointment Questionnaire