Forms

NEW CLIENT QUESTIONNAIRE – If you are a new client and would like to fill-in this form online, you may do so here.  Please print the form upon completion and bring it with you to your appointment.  The option to fill-in this form online may not be available on mobile devices.

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.