Elder Law Contact Form

It is estimated that nearly four million Americans suffer some form of mental dementia, most commonly Alzheimer's Disease. That figure is expected to triple by 2050. With the onset of dementia comes the growing need for assistance with such common daily tasks as dressing and feeding oneself, administering to even modest financial matters, and providing for one's own medical care. If you have a loved one who has difficulty making sound financial and lifestyle decisions, contact an experienced elder law attorney to discuss the possibility of establishing a guardianship or conservatorship to aid your loved ones.

The elder law attorneys at the law firm of Polizzotto and Polizzotto, LLC understand from both our personal and professional experience how emotional and financial hardships that can come about as your loved ones grow older. We offer legal counsel and representation to help you through the myriad of issues that are covered under elder law. Our attorneys can help with Medicaid planning and nursing home issues, estate planning questions, trust preparation, as well as matters requiring guardianships or conservatorships. Below is helpful information to answer some of your questions on elder law.

Contact Polizzotto and Polizzotto, LLC for a consultation on your elder law matter for a frank, in-depth discussion of the legal principles and procedures involved in resolving your situation.

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Elder Law Contact Form

Name

Email Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

What is your marital status?

What is your age?

Do you own your home?
Yes  No 

Does anybody else reside with you at your home?
Yes  No 

Have you executed a will, trust, power of attorney, living will, health care proxy or any other estate planning document?
Yes  No 

If yes, please indicate the type of document.

Are you currently receiving assistance from Medicare, Medicaid, Social Security, or any other government program?
Yes  No 

If yes, please specify the nature of your assistance.

Do you have a long-term care insurance policy?
Yes  No 

If yes, please provide the name of your insurance company and amount of coverage, if known.

Do you have any chronic physical or mental conditions for which you have sought medical attention?
Yes  No 

If yes, please specify each condition.

Do you have a family history of physical or mental conditions requiring prolonged medical attention?
Yes  No 

If yes, please specify each condition.

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

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