Preferred Contact Method:

Applicant’s Marital Status:

Living Situation:

Does the applicant live with anyone else?

Are there children or dependents financially supported by the client?

Does the client have any of the following?

Is the applicant’s primary home in their name?

Any financial transfers or gifts made in the last 5 years?

(Leave blank if assets are held jointly with client alone.)

Does the spouse have any of the following?

Is the applicant’s primary home in their name?

Any financial transfers or gifts made in the last 5 years?

Does the applicant currently receive:

Medicaid/insurance coverage (check all that apply):

About Conservatorship Support: We offer non-legal support for adults and families seeking voluntary conservatorship through the Connecticut Probate Court. If you check this service, we’ll help you understand the process, prepare documents, and stay organized—without offering legal advice. We’re here to make the process easier.

How did you hear about us?

Would you like to schedule a free 15-minute discovery call?

Client Information

Service Overview

Compass Medicaid Consultants, LLC offers non-legal administrative support to clients and families navigating the Connecticut Voluntary Conservatorship process. We assist with gathering documents, preparing forms, and coordinating with the local Probate Court. We do not provide legal advice or legal document preparation.

Included Services

Each service includes:
· Written checklist of required documents
· General guidance on completing forms (e.g., PC-300)
· Referral to an elder law attorney if legal representation is recommended
· Coordination with care teams or family when appropriate

Legal Disclaimer

By signing this agreement, the client acknowledges and agrees to the following:
· Compass Medicaid Consultants, LLC is not a law firm and does not provide legal advice.
· We do not complete or file legal documents on behalf of clients.
· We strongly encourage clients to seek assistance from a qualified attorney when:
· There are questions of capacity or guardianship
· Disputes may arise between family members
· The Probate Court requests legal clarification
· Compass Medicaid Consultants assumes no responsibility for court decisions, case outcomes, or missed deadlines due to incomplete filings.

Signatures