Instructions for Completing this Form

Fill out each section as completely and accurately as possible.
Submit the form directly through Clio using the Submit button.
If you have questions or need clarification while filling out the form, please email us at jon.hays@hayslawva.com or call [phone number].
Once submitted, our team will review your responses and contact you for any necessary follow-ups.

Note: Once you have signed a retainer, you will receive a detailed questionnaire to provide all vital information needed for your estate planning case.

Contact information

Prefix

First name *

Middle name

Last name *

Emails

Email Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Contact information

What type of estate planning services are you seeking? (Select all that apply):

Spouse/Partner’s Full Name:

Names and Ages of Children:

Are there any other dependents you wish to include?

Do you own real estate?

Do you have financial accounts (e.g., savings, retirement, investments)?

Do you own any businesses?

Do you have life insurance policies?

Who do you want as the primary beneficiary of your estate?

Do you have alternate beneficiaries?

Who do you want to serve as your executor or trustee?

Do you have alternate choices for these roles?

Do you have any specific concerns (e.g., blended families, special needs children)?

Are there any unique considerations for your estate plan?

Do you have any other details or concerns you would like to share?

Are you a member of ARAG Legal Insurance Plan?