Guardianship Questionnaire - Sussan, Greenwald & Wesler

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This simple intake questionnaire will help us prepare for our first meeting.

Please provide the following information about the person in need of guardianship.

Full Legal Name(Required)

Birth Date(Required)

Gender(Required)

What is the marital status of the person in need of guardianship?(Required)

Please state marital status(Required)

Does the person in need of guardianship have any children?(Required)

Child's Full Name(Required)

Child's Birth Date(Required)

Child's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Is the person in need of guardianship in agreement with your appointment as guardian?(Required)

Does the person in need of guardianship require full or limited guardianship?(Required)

If limited, in what areas can the person in need of guardianship manage their own affairs?(Required)

Describe the person in need of guardianship's physical attributes.

Height(Required)

Weight(Required)

Hair Color(Required)

Eye Color(Required)

Eligibility Questions

Is the person in need of guardianship registered with DDD?(Required)

Is the person in need of guardianship eligible for Social Security Income (SSI)?(Required)

Have you applied for Social Security Income (SSI)?(Required)

Is the person in need of guardianship adopted?(Required)

Does the person in need of guardianship have a disabling condition?(Required)

What is the alleged incapacitated person’s diagnosis?(Required)

Where does the person in need of guardianship currently live?

Does the person in need of guardianship reside at home?(Required)

Where does the person in need of guardianship reside?(Required)

Has the person in need of guardianship ever been institutionalized?

Has the person in need of guardianship ever been institutionalized?(Required)

Where?(Required)

When?(Required)

Date of Release(Required)

Has the person in need of guardianship signed financial or health care powers of attorney documents?(Required)

Provide financial information for incapacitated person.

Amount of monthly SSI recieved, if eligible for SSI:(Required)

Property(Required)

Property value(Required)

Add another property?

Yes

Property(Required)

Property value(Required)

Add another property?

Yes

Property(Required)

Property value(Required)

Do you have a trust and/or will?

A supplemental Needs Trust (sometimes called a Special Needs Trust) is a specialized legal document designed to benefit an individual who has a disability. Established to Preserve Governmental Benefits And Protect Assets. Please check below.

Do you have a Special Needs Trust?(Required)

A will is one of the most important estate planning documents you can have as it protects your assets and those of your loved ones. You should review an update your Will to reflect changes in your life such as marriages, the birth of a child, death, changes of financial status or revisions of estate laws in New Jersey.

Do you have a will?(Required)

Provide bank and deposit information for incapacitated person, if any.

Bank(Required)

Amount on deposit(Required)

Add another bank/deposit?

Yes

Bank(Required)

Amount on deposit(Required)

Add another bank/deposit?

Yes

Bank(Required)

Amount on deposit(Required)

Please provide detailed information for the proposed guardian(s).

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone Number(Required)

Home Phone Number(Required)

Business Phone Number(Required)

FAX(Required)

Email(Required)

Date of birth(Required)

Relationship to person in need of guardianship(Required)

Add Second Guardian

Yes

Hidden

Section Break

Full Legal Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone Number(Required)

Home Phone Number(Required)

Business Phone Number(Required)

FAX(Required)

Email(Required)

Date of Birth(Required)

Relationship to person in need of guardianship(Required)

Hidden

Section Break

Provide any information regarding siblings of person in need of guardianship.

Does the person in need of guardianship have any siblings?(Required)

Hidden

Sib1

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Add second sibling

Yes

Hidden

sib2

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Add third sibling

Yes

Hidden

sib3

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Add fourth sibling

Yes

Hidden

sib4

Full Legal Name(Required)

Date of Birth(Required)

Gender(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Hidden

Section Break

Provide all information for the medical doctor that will support guardianship.

I understand that in order to proceed with the guardianship I must provide two physician certifications, or a certification by one physician and one DDD case worker familiar with the person in need of guardianship (Only if the person is receiving services from DDD). I understand that SGW is required to file these certifications within a specific time frame after they are completed. 

I agree to the above statement(Required)

Yes

Legal Name of the Medical Doctor who will support Guardianship(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Phone Number(Required)

Fax Number(Required)

Email(Required)

Relationship to person in need of guardianship(Required)

Add a second doctor

Yes

Hidden

Section Break

Legal Name of the Medical Doctor who will support Guardianship(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Business Phone Number(Required)

Fax Number(Required)

Email(Required)

Relationship to person in need of guardianship(Required)

Hidden

Section Break

Who referred you?

We'd love to know — how were you referred to us?(Required)

ex.: a friend's recommendation, our website, etc.

End of Guardianship Questionnaire

Enter your email to complete this form.(Required)

Thank you for completing the Guardianship Questionnaire. Our office will contact you with any further questions. If you don't receive confirmation in your email, please check your junk mail.

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REGULATIONS Part 300
A.D.A. AMERICANS WITH DISABILITIES ACT
28 C.F.R. Part 35 28 C.F.R. Part 35
NONDISCRIMINATION ON THE BASIS OF DISABILITY IN STATE AND LOCAL GOVERNMENT SERVICES
REHABILITATION ACT OF 1973 SECTION 504
FAMILY EDUCATION RIGHTS & PRIVACY ACT (FERPA)
DEVELOPMENTAL DISABILITIES ASSISTANCE AND BILL OF RIGHTS ACT OF 2000
U.S. COURTS OF APPEALS
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FEDERAL REGISTER
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