Please download or print out our questionnaire(s).
We have three primary questionnaires. Although it is not required, we find that if you will complete as much of the questionnaire(s) as possible and submit it to use in advance of your initial consultation, our time together will be much more productive. We review your answers in advance of the consultation, and this permits us to be more prepared for our meeting and allows us to focus on the specific issues you wish to address.
Please complete the form(s) to the extent possible, but do not feel obligated. However, remember that the more information you provide to us, the more productive our initial consultation will be. The forms may be returned via email, fax, U.S. mail, or hand-delivery. Please try to get the information to us at least 48 hours in advance of your consultation.
It is not necessary to repeat information on multiple questionnaires.
Long Term Care Planning Questionnaire: Primarily used for planning for nursing home, assisted living facility or home health care planning where Medicaid may be needed to pay costs of health care.
Veterans Benefit Questionnaire: This is used when a person is a Veteran, or is a surviving spouse of a Veteran, and there are significant health care expenses for the Veteran or spouse and assistance is needed for activities of daily living such as bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.
Even if you are filling out the Long Term Care Planning Questionnaire, please fill this out as well if you are a Veteran or surviving spouse of a Veteran.
Estate Planning Questionnaire: This form is primarily used if you are seeking preparation of estate planning documents such as a Durable Power of Attorney, Last Will and Testament, Revocable or Irrevocable Trust, Health Care Surrogate Designation and Living Will forms, or Special Needs Trusts, and long term care planning or VA benefits to assist with health care expenses is not needed.
Please fill out the questionnaire, to the best of your ability, and return it to us via fax, mail, email or hand-delivery prior to your appointment.
You may also contact Amy Morris at Amy.Morris@TBELC.com and she will be happy to send the forms to you in alternative formats.
Thank you very much. We look forward to meeting with you soon.
Tampa Bay Elder Law Center