Forms

New Client Questionnaire Form – This form may be printed, completed and brought with you to your initial appointment if you plan to make an appointment with our office.  At the time an appointment is made, this form will be provided to you by mail or emailed to you for completion.

DHHS Appointment of Representative Form – If you are a client and our office is assisting you with an application for long-term care benefits with the Department of Health & Human Services (DHHS), you may print this form to allow us to act as your representative for yourself or a family member in the application process with DHHS.  The original executed form should be provided to our office.

DHHS Authorization to Release Information Form– If you are a client and our office is assisting you with an application for long-term care benefits with the Department of Health & Human Services (DHHS), you may print this form to allow us to communicate with DHHS about existing long-term care coverage or a pending issue or long-term care application for yourself or a family member.  The original executed form should be provided to our office.