CONFIDENTIAL GUARDIANSHIP QUESTIONNAIRE

The following questionnaire is designed to expedite our efforts in representing you in the Article 81 Guardianship proceeding. Whether you are a new or an established client, we have found this questionnaire extremely helpful, and therefore ask you to complete it prior to your appointment. Those questions that do not apply to your family or financial situation may simply be left blank. Please feel free to attach additional pages where space is needed or to provide other information you feel is relevant. There is a space below to upload any of your documents securely. Our site uses SSL Encryption to protect your data.

NOTE: IF YOU NEED TO COME BACK TO COMPLETE THE QUESTIONNAIRE, YOU CAN HIT “SAVE AND CONTINUE” AT THE BOTTOM OF THIS PAGE. YOU WILL RECEIVE AN EMAIL WITH A LINK TO CONTINUE/COMPLETE THE QUESTIONNAIRE.

GUARDIANSHIP TERMINOLOGY

Guardianship proceedings under New York State law require a basic understanding of certain terminology. The legal definition of the person for whom you are requesting a Guardian is the Alleged Incapacitated Person (AIP); the person who petitions the Court is the Petitioner; and the person whom the Court appoints is the Guardian of Personal Needs and/or Property Management. The Petitioner and the Guardian may be the same person, or different persons. One person may be the Guardian for both Personal Needs and Property Management, or there may be a separate Guardian for each.
NOTE: IF YOU NEED TO COME BACK TO COMPLETE THE QUESTIONNAIRE, YOU CAN HIT “SAVE AND CONTINUE” AT THE BOTTOM OF THIS PAGE. YOU WILL RECEIVE AN EMAIL WITH A LINK TO CONTINUE/COMPLETE THE QUESTIONNAIRE.
MM slash DD slash YYYY
Name(Required)
Address(Required)
Address of AIP
MM slash DD slash YYYY
Will you propose a change of residence for the AIP?
Do you believe the AIP will oppose appointment of a Guardian?
If you are not interested in being Guardian, provide the name(s) of proposed Guardians
Name
Address
Phone Number
Relation
 
Please use the + button to the right to add additional proposed Guardians.
Would any of the proposed Guardians have difficulty obtaining a bond?
A bond is a required insurance policy which may be required by the Court ensuring that the Guardian properly discharge their duties.
Are there any emergencies requiring immediate action? (Check all that apply)

Functional Limitations of AIP

Please indicate whether the AIP can or cannot perform the following by themselves.
Is the AIP currently employed?
Does the AIP have business responsibilities?
Does the AIP have responsibilities for others?

AIP Health Information

Does the AIP have any medical or psychiatric problems and diagnoses?
List any health care providers
Name
Specialty
Phone Number
 
Please use the + to the right to add additional health care providers
Medications the AIP is currently prescribed
Medication
Dose
Pharmacy
 
Please use the + to the right to add additional medications
Recent hospitalizations
Hospital
Date
Length of Stay
 
Please use the + to the right to add additional dates
How is payment made for medical bills? (check all that apply)
Does the AIP have a Health Care Proxy?
Does the AIP have a Living Will?
Does the AIP have a Do Not Resuscitate Order (DNR)?
Should competency of the AIP at the time of signing any of the above be questioned?

Relatives of AIP

Please list spouse, parents, adult siblings, adult children or other close relatives of the AIP.
Relative
Name
Relation
Addresss
 
Please use the + button to the right to add additional relatives.

Other Interested Parties

Please other interested parties.
Person(s) with whom the AIP resides
Name
Address
Phone Number
 
Please use the + button to the right to add additional names.
Person(s) with whom the AIP appointed under a Health Care Proxy
Name
Address
Phone Number
 
Please use the + button to the right to add additional names.
Person(s) with whom the AIP appointed under a Power of Attorney
Name
Address
Phone Number
 
Please use the + button to the right to add additional names.
Person(s) who regularly visit the AIP
Name
Address
Phone Number
 
Please use the + button to the right to add additional names.
Any Public Agency that assists the AIP
Name
Address
Phone Number
 
Please use the + button to the right to add additional names.
Person(s) who regularly communicate with the AIP (ie: phone, email, mail)
Name
Address
Phone Number
 
Please use the + button to the right to add additional names.

AIP's Professional Advisors

Please provide contact information for attorneys, financial advisors, brokers, insurance agents, etc.
Advisor
Name
Title
Email Address
Phone Number
 
Please use the + button to the right to add additional advisors.

AIP's Assets

Please provide information regarding any personal assets of the AIP. If you have statements, deeds, property tax bills, etc., please attach them below, or bring them to your appointment.
Please List Any of the AIP's Monthly Income (ie: Wages, Social Security, Retirement, Other)
Income Source
Amount
 
Please use the + button to the right to add additional income.
Please List the AIP's Monthly Expenses (ie: Rent, Mortgage, Vehicle Loans, Food, Utilities, Etc.)
Expense
Amount
 
Please use the + button to the right to add additional expenses.
Bank Accounts
Name of Financial Institution
Account Value
Purpose of Account
 
Please use the + button to the right to add additional accounts.
Does the AIP Own Real Property?
Please List Any Valuable Personal Property Belonging to the AIP (ie: Vehicles, Jewelery, Home Furnishings, Artwork)
Item
Estimated Value
 
Please use the + button to the right to add additional personal property.
Large withdrawals of money from bank or stock accounts, transfers of real property, trusts created, etc.

Thank You

Thank you for taking the time to complete this questionnaire; it is very helpful for your appointment. If you have any questions regarding this questionnaire or your appointment, please contact James Gonda at 518-459-2100.
Please provide any relevant documents you would like to share with our attorneys.
Drop files here or
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