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Elder Law Form

If you would like to schedule a consultation, you may use the form below.

Alternatively, you may contact us as follows.

Grosskopf & Black, LLC
1324 West Clairemont Avenue, Suite 10
Eau Claire, Wisconsin 54701
715.835.6196
info@eclawyers.com

NOTE: An asterisk (*) indicates REQUIRED information. The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

* Required fields
Name *
E-mail Address *
County of residence
Are you:
Do you have a spouse?	Yes No
If yes, is your spouse:
If you own a home, what is its value?
	Check if looking at protecting your home
	Check if looking at protecting the farm
	Check if looking at protecting the cottage
	Check if you are looking at getting you or your spouse eligible for Medicaid as soon as you can
	Check if you are just pre-planning for eventual Nursing Home issues
	Check if Looking at all ways to avoid if possible any Nursing Home placement
	Check if you need a will
	Check if you need a trust
	Check if you need a Health care power of attorney
	Check if you need a Financial power of attorney
	Check if looking or in need of something not listed

I have read and agree to the Privacy Policy *

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© 2000-2008, Grosskopf & Black, LLC
1324 West Clairemont Avenue, Suite 10
Eau Claire, Wisconsin 54701
715.835.6196
info@eclawyers.com

Serving Clients from Eau Claire, Chippewa Falls, Elk Mound, Osseo, Fairchild, Fall Creek, Augusta, Altoona, Cadott, Boyd, Stanley, Eleva, Strum, Mondovi, Durand, Caryville, Mondovi, Boyceville, Wheeler, New Auburn, Cornell and surrounding communities.