We ask that all new clients complete the brief questionnaire below. This will help us determine your needs and the legal services that align with your objectives. Once you submit the form, a representative from our office will review it and contact you within 24 hours.

Your Full Legal Name (First, Middle, Last) *

Is the request for you or a third party? *

Myself

Third Party

If a third party, what is the individual or individuals' full legal name or names? (First, Middle, Last)

Your Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

How did you learn about Oregon Elder Law?

Referral

Internet Search

Other

If referred, who gave you the referral?

Were you referred to an attorney or the firm?

Referred to Oregon Elder Law

Referred to Whitney Yazzolino

Referred to Julie Meyer Rowett

Referred to Gina Goddard

What assistance do you require? Please choose one or more. *

Estate Planning

Medicaid & Long-Term Care Planning

Guardianships & Conservatorships

Special Needs Trusts

Probate & Simple Estates

Trust Administration

Other (Please explain below)

Are you receiving any public assistance?

Yes

If so, what type of public assistance do you receive?

How can we help you? *

Thank you for choosing Oregon Elder Law! We will contact you shortly regarding how we can best serve you.

Oregon Elder Law
Yazzolino & Rowett, LLP
2173 NE Broadway Street
Portland, Oregon 97232
Telephone: (503) 284-6778

Please note that contacting Yazzolino & Rowett, LLP does not create an attorney-client relationship. If you wish to discuss the provision of legal services, please do not include any confidential information in your communications with us until we have confirmed that we can assist you and do not have any conflicts of interest with existing clients.

Estate, Disability & Longterm Care Planning