Client Intake Form

How did you hear about us?

Facebook

Instagram

Referral

Previous Client

What is the best day to contact you?

MM

DD

YYYY

What is the best time to contact you?

Hour

Minute

Second

AM PM

Did you file a 2023 tax return?

Yes

No

Unsure

Taxpayer's Name

First Name

Last Name

Taxpayer's Phone Number

(###)

###

####

Taxpayer's Date of Birth

MM

DD

YYYY

Spouse's Name

First Name

Last Name

Spouse's Date of Birth

MM

DD

YYYY

Spouse's Phone Number

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Filing Status

Single

Head of Household

Married Filing Seperate

Married Filing Joint

Qualifying Widower

Are you self employed?

Yes

No

Did you and your spouse live apart during the year?

Yes

No

Not Applicable

Did you pay over half the expenses of maintaining your residence for the entire year?

Yes

No

Did you support a child or family member for more than 6 months out of the year?

Yes

No

If yes, did you live together at any time after June 30, 2023?

Yes

No

Not Applicable

Have you ever been denied the Earned Tax Credit (EITC)?

Yes

No

Not Applicable

Do you receive any Government Assistance?

Yes

No

Not Applicable

Are you a full-time student?

Yes

No

Can someone else claim you as a dependent?

Yes

No

Are you totally and permanently disabled?

Yes

No

Are you legally blind?

Yes

No

Were you issues an identity Pin from the IRS

Yes

No