CONTACT US

Address: 3325 N. Arlington Hts Road Suite 500, Arlington Heights, Illinois, 60004, US
Telephone: (847)253-7500

Home CONTACT US

2.5k

VIEWS

Facebook Twitter Google Mail

Contact the Law Office of James C. Siebert & Assoc1ates, P.C. / Elder Law & Estate Planning Attorneys of Illinois, P. C.

Thank you for interest in the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C. Please complete the form below and someone from our office will get back to you to discuss your concerns or to schedule an initial consultation.

In the alternative, you can call the office at (847)253-7500 to schedule the initial consultation.

Please Complete the following

Your Name*
First Middle Last
Contact's Address*
Street Address City State ZIP Code
Your Email*
Your Phone Number*
Are you contacting us about yourself or someone else?*
- Myself
- Someone else
Contact's Marital Status*
- Married
- Single never married
- Divorced
- Widow or Widower
- Civil Union
What is your marital status?
Contact's Spouse's Name*
First Middle Last
If you are married or in a civil union please provide your spouse's or partner's name
Name of Potential Client*
First Middle Last
Please provide full name of who you are contacting us in regard
Potential Client's City and State*
City State

Please provide the City and State where this individual currently resides.
Potential Client's Marital Status*
- Married
- Single never married
- Divorced
- Widow or Widower
- Civil Union
What is that person's marital status?
Potential Client's Spouse's Name*
First Middle Last
If married or civil union please provide the spouse or partner's name
Your Relation to Potential Client*
- Spouse
- Son or daughter
- Step son or Step daughter
- Brother or Sister
- Parent
- Grandparent
- Uncle or Aunt
- Friend
Agent under Power of Attorney*
- Agent Power of Attorney Property
- Agent Power of Attorney Health
- Not Agent under Power of Attorney
Are you this person's agent under a Durable Power of Attorney? (mark all that apply)
Areas of Law*
- Elder Law
- Asset Preservation
- Medicaid or Long Term Care Planning
- Medicaid Qualification or Application
- Medicaid Decision Appeal
- Estate Planning General
- Trust Estate Planning
- Irrevocable Trusts
- Special Needs Planning and Trusts
- Probate Decedent's Estate
- Trust Administration Decedent's Estate
- Child Caregiver Agreement
- Guardianship
- Nursing Home Contract Issues
- Nursing Home Injury or Abuse
- Residential Real Estate
- Durable Powers of Attorney
- Other
Please identify the areas of law you are contacting us in regard. Please mark all that you believe apply.
Brief Description of the matter*
Please provide a brief description of the matter you wish to discuss. Please provide as much relevant information as you believe appropriate.
Preferred contact method
- E-mail
- Phone
How found Office
- Internet search
- Referral
- National Academy of Elder Law Attorneys
- Illinois State Bar Association
- AVVO
- Other
How did you find out about our office? Please mark all that apply.
If referral or other
If referral or other, please provide the name of the person or organization.
Email
This field is for validation purposes and should be left unchanged.

WARNING: Sending a message through this Website or by e-mail does not establish an attorney-client relationship. If you are not a client, your e-mail is not privileged or confidential. If you are a client, remember information sent through this Website or by e-mail may not be secure – do not send sensitive or confidential information unless it is encrypted. Please review the terms of the Law Office of James C. Siebert & Associates, P.C. /Elder Law & Estate Planning Attorneys of Illinois, P.C.’s Privacy Policy and Disclaimer for more information.

Click the link in this sentence or below If you need Directions to the Law Office of James C. Siebert & Associates, P.C.

DISCLAIMER
PRIVACY POLICY
CONTACT US
DIRECTIONS

Elder Law & Estate Planning Attorneys of Illinois, PC
Law Office James C. Siebert & Associates, PC
3325 N. Arlington Heights Rd., Suite 500, Arlington Heights, IL 60004
Phone: 847-253-7500 - Fax: 847-253-1904 - E-mail: info@jcslaw.com

Close

Please Like our Facebook Page

Do you already like us on Facebook?

Do not ask me again for Facebook

Continue to the article »