Mayhone Elder Law - Adult Incapacity Plan - Questionnaire

Welcome to the Mayhone Elder Law Young Adult Incapacity Plan!

Before you begin, here are a few tips to guide you:

1. Answer thoughtfully, but do not overthink it. These questions are designed to help you consider important decisions. All responses will be reviewed by a qualified attorney and can be revised as needed.

2. The process is quick and easy, typically taking about 15–20 minutes to complete.

3. You can revisit the site at any time to make updates or changes using the username and password you created.

4. Once you are satisfied with your answers, click “Submit” to finalize them. You will then be directed to complete payment for your plan.

5. After submission and payment, a licensed attorney will review your responses and prepare the documents for signing.

If you run into any issues or problems, reach out to our team for assistance at (228) 215-1223

Registration Info
Please use your legal name as it appears on your license or government-issue ID

Provide your details below to get started on your Young Adult Incapacity Plan

First Name *

Middle Name

Last Name *

Email *

Password *

Cell *

Young Adult Info
Please provide the name of your college student. You are filling this out for them; their name will be selected as the primary” in the document while you can provide your name as their agent.

Are you a parent filling this out for your college student? *

✓

Yes

✓

No

Please select "Are you a parent filling this out for your college student?".

Your Contact Details
Please submit all answers with the proper capitalization. Your full legal name is required for your estate planning documents. This would be the name you are referred to on your driver’s license, social security card, passport or other federal government ID. Do not forget to add your middle name or initial if you have one. If your driver’s license, social security card, passport, or other forms of identification do not match, use the full name indicated on your driver’s license and list the other name in the “also known as” field. Also known as names are names that you may regularly use for financial documents, health care policies, or just more commonly known as.

Name:

Date Of Birth *

Also known as(optional)

Suffix(optional)

✓

Jr

✓

Sr

✓

II

✓

III

✓

Other

Gender

✓

Male

✓

Female

Your Address

Full Address: *

State

Power of Attorney
The Power of Attorney allows the person you name as your agent to make legal and financial related decisions for you while you are alive. The power will become effective at the time you sign the Power of Attorney and will continue in the event of your incapacity. The Power of Attorney powers stop upon your death. It is recommended that you name one primary (typically spouse/partner if married) and at least one alternate agent.

Provide the information of one or more individuals who will serve as your agent under the Durable Power of Attorney:

Primary Agent: *

Phone Number *

Address *

Alternative Agent: * Click the "+" button to add more agent

Phone Number: *

Address: *

Health Care Proxy
Your Health Care Agent will make medical decisions for you if you are incapacitated and unable to do so yourself. When picking a Health Care Agent, pick someone who would be comfortable serving in this role. Also, consider whether that person would have similar ideas as to you regarding medical care. If your doctors ever need to say that there is nothing further they can do except to keep you hooked up to machines, and you would not want that, don’t pick someone who would feel the opposite or too burdened to have to make those kind of decisions.

Please provide the information of one or more individuals who will serve as your health care agent:

Do you wish to use the same agents as your Power of Attorney? *

✓

Yes

✓

No

Primary Agent:

Alternative Agent: * Click the "+" button to add more agent.

Congratulations! You have completed your online estate plan interview.

Please review your responses carefully. Once you’re satisfied, click ‘Submit’to send your interview to us. This is an important step toward completing your estate plan.

After submitting:

1. You will be directed to a webpage to pay for your plan.

2. Once payment is received, our office will reach out to schedule your plan review and signing session.

3. During this session, our team will walk you through your plan, answer any questions, and ensure everything reflects your wishes.

4. After the review, we’ll guide you through the proper signing and execution process so you leave with a fully active and effective plan.

Important: Your estate plan is not complete until it is properly signed and executed. We are not engaged to provide assistance until payment has been received.

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