Legal Check-Up

Are you all set legally? Or do you need to take steps to protect yourself and your family from:

	Lawsuits
	Divorce
	Taxes
	Costs of long-term care
	Premature death

Answer the following questions to learn whether you need to take any steps to protect yourself, your savings and your family. We will keep your answers in the strictest confidence and respond to you by e-mail the next business day.

* = Required response

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First Name *

Last Name *

E-mail Address (we will keep your e-mail completely private)*

1. What U.S. state or territory do you reside in? *

2. What is your age?

3. Are you married? *

Yes
No

Is this your first marriage?

Yes
No

Are you living with a partner?

Yes
No

4. Do you have any children?

Yes
No

Are any of them minors?

Yes
No

Do any of them have any disabilities?

Yes
No

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5. Do you own your own home?

Yes
No

6. Do you own other real estate?

Yes
No

Is this a rental property?

Yes
No

Is this a vacation property?

Yes
No

7. Approximately how much do your savings and investments total?

8. Check which of the following documents you have

Will
Durable Power of Attorney
Medical Directive (living will or health care proxy)
Revocable Living Trust
None of the above

9. Have you or any other family member been divorced, faced bankruptcy or been the subject of a lawsuit?

Yes
No

10. Do you have copies of all your beneficiary designations on your life insurance and retirement accounts?

Yes
No

11. Have you or anyone in your family been seriously injured or died as the result of an automobile accident, the action of a doctor, from any medication or medical device, or in a nursing home?

Yes
No

You or your family member may be entitled to compensation for your injury. With your permission, we will pass your contact information on to a law firm that can evaluate whether you or your family members has a claim. May we do so?

Yes
No

12. Have you taken steps to plan for the possible need for long-term care, such as purchasing long-term care insurance?

Yes
No

The cost of long-term care, whether at home, in assisted living, or in a nursing home, can exhaust the savings of all but the most affluent. You can take steps to make sure that that does not happen to you, either by buying long-term care insurance or through estate planning measures. Would you like us to have someone contact you about:

Long-term care insurance
Long-term care estate planning

Disclaimer

I have read and agree to the Legal Check-Up disclaimer.

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Law Office of Lawrence Solorio
5150 Sunrise Boulevard
Suite D-1
Fair Oaks, CA 95628
(916) 536-1773