Tax Client Intake Form

Personal Information

First name *

Middle initial

Last name *

Date of birth *

SSN — last 4 digits *

Phone number *

Email address *

Home address *

Filing Status

Spouse Information (if filing jointly)

Spouse full name

Spouse date of birth

Spouse SSN — last 4

Dependent Information

Optional

General Questionnaire

Answer Yes or No for each item. Leave blank if unsure — we can discuss during your appointment.

Question	Yes	No
Personal Status
Did your marital status change during 2025?	Y	N
Do you or your spouse plan to retire in 2025 or the coming year?	Y	N
Were you or your spouse permanently and totally disabled in 2025?	Y	N
Were you or your spouse a member of the U.S. Armed Forces during 2025?	Y	N
Do you want your tax preparer to discuss this return with the IRS on your behalf?	Y	N
Dependents
Do any of your dependents need to file their own return?	Y	N
Do you have children under 19 (or full-time student under 24) with investment income over $2,100?	Y	N
Are any of your dependents not U.S. citizens or residents?	Y	N
Did you provide over half the support for any other person during 2025?	Y	N
Did you incur adoption expenses during 2025?	Y	N
IRA, Pension & Education
Did you receive payments from a pension or profit-sharing plan?	Y	N
Did you receive a distribution from an IRA/qualified plan and roll it over within 60 days?	Y	N
Did you convert a regular IRA to a Roth IRA, or roll a qualified plan into a Roth IRA?	Y	N
Did you contribute to a Coverdell Education Savings Account?	Y	N
Income & Losses
Did you receive any disability payments in 2025?	Y	N
Did you receive tip income not reported to your employer?	Y	N
Did you buy, sell, refinance, or abandon a principal residence or other real property in 2025?	Y	N
Did you incur any casualty or theft losses during 2025?	Y	N
Did you incur any non-business bad debts?	Y	N
Did you receive any income not already captured on your documents?	Y	N
Did a lender cancel any of your debt in 2025? (Attach 1099-A or 1099-C if applicable)	Y	N
Foreign Accounts & Income
Did you have a foreign bank account or financial account at any time during 2025?	Y	N
Did the aggregate value of all foreign accounts exceed $10,000 at any time during 2025?	Y	N
Did you have foreign income or pay any foreign taxes in 2025?	Y	N
Did you have interest in or authority over foreign assets exceeding $50,000 in value?	Y	N
Health & Insurance
Did you or your spouse have self-employed health insurance?	Y	N
Did you receive Form 1095-A (Marketplace health coverage)?	Y	N
Did your employer pay premiums on life insurance over $50,000 with named beneficiaries?	Y	N
Did you contribute to or receive distributions from a Health Savings Account (HSA)?	Y	N
Miscellaneous
Did you make energy-efficient improvements to your home in 2025?	Y	N
Did you purchase an energy-efficient vehicle in 2025?	Y	N
Did you donate a vehicle in 2025? (Attach Form 1098-C)	Y	N
Did you make gifts of over $18,000 to an individual or contribute to a prepaid tuition plan?	Y	N
Did you pay interest on a student loan for yourself, spouse, or dependents?	Y	N
Did you, your spouse, or your dependents attend post-secondary school in 2025?	Y	N
Did you pay any individual for domestic services in 2025 (household employee)?	Y	N
Were you notified by the IRS or state taxing authority of changes to a prior year's return?	Y	N
Electronic Filing & Refund
Would you like to file electronically (e-file)?	Y	N
If a refund is due, would you like direct deposit?	Y	N

Document Checklist

Check all documents you have available to send or bring to your appointment.

Business / Self-Employment

Optional

Do you have business income to report this year? Select all that apply — or skip this section if not applicable.

Schedule C — Sole Proprietorship

Business name

Business type / industry

Approximate gross income

Approximate total expenses

Schedule C document checklist

Income records / bank statements Expense receipts / records Mileage log Home office info (sq. ft.) Asset purchase receipts (equipment) 1099s received from clients

Do you need help reporting business expenses, deductions, or depreciation?

Partnership — Form 1065

Partnership name

EIN

Number of partners

Tax year end

Partnership document checklist

Partnership agreement Prior year Form 1065 + K-1s Profit & loss statement Balance sheet Asset additions / disposals Partner distributions

Do you need help reporting partnership expenses, deductions, or allocations?

S-Corporation — Form 1120-S

Corporation name

EIN

Number of shareholders

State of incorporation

S-Corp document checklist

Prior year Form 1120-S + K-1s Profit & loss statement Balance sheet (beginning & end) Payroll / W-2 records Shareholder distributions Asset depreciation schedule

Do you need help reporting S-Corp expenses, deductions, or shareholder basis?

Additional Notes

Optional

Any life changes in 2025? (new job, moved, married, new child, retirement, sold property, etc.)

Questions or concerns for your preparer

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By submitting this form, I certify that the information provided is accurate and complete to the best of my knowledge. I understand this information will be used solely for the purpose of preparing my tax return.

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