Intake Form

What is your current address?

What is your full legal name and date of birth?

What was your marital status last year? Please list your spouse’s full legal name and date of birth.

Do you have any dependents? If yes, please list the dependents full legal names and their date of birth.

Were there any changes in dependents?

Did you have any child or dependency care expenses? Please include care provider's name, address, SSN, and amount.

Did you buy or sell stocks, mutual funds, bonds, or other investment properties?

Did you donate money, clothes, cars, or stock?

Did you incur any tuition or continuing education expenses?

Did you receive a distribution from or make a contribution to a retirement plan (401(k), IRA, etc.)?

Did you, your spouse and dependents have health care coverage for the full-year?

Did you receive any of the following IRS documents? Form 1095-A, 1095-B, or Form 1095-C? If so, please send.

For direct deposit, please provide your bank name, routing number, and account number.

Do you want to electronically file your tax return?

Please list any questions or other concerns you might have.

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