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Petition for Guardian/Conservator Questionnaire
For those wishing to care for an incapacitated person
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What is your legal issue?
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Choose
Guardianship/Conservatorship
Today's Date
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MM
/
DD
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YYYY
How did you find out about Middle Georgia Justice?
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Courthouse
Friend
Online
Previous Patron
Tax Assessor's Office
Attorney's Office
Other:
Your Name
Your answer
Your Current Address
Your answer
Your Phone Number
Your answer
Your Email address
Your answer
Name and date of birth of incapacitated person (the proposed ward)
Your answer
Your relationship to the proposed ward
Your answer
What is the address where the proposed ward lives?
Your answer
Is the proposed ward a citizen of the United States?
Yes
No
Clear selection
Is the proposed ward a citizen of any other country.
Yes
No
Clear selection
Phone number for the proposed ward
Your answer
Did the proposed ward live in any other state in the last 6 months? If so, where?
Your answer
Does the proposed ward live alone? If no, who lives with the proposed ward?
Your answer
Does the proposed ward have a wife or any children? Please provide names, addresses and phone numbers.
Your answer
Why do you think the proposed ward is incapacitated?
Your answer
Has a physician, psychologist, or licensed clinical social worker examined the proposed ward?
Yes
No
Clear selection
If yes, when was the exam and do you have a copy.
Your answer
Is this an emergency situation?
Your answer
Have there been any other legal proceedings filed on behalf of the proposed ward? If so when and what court.
Your answer
Is a guardianship necessary because the proposed ward lacks capacity to make or communicate significant responsible decisions concerning their health or safety? Please explain.
Your answer
Is a conservatorship necessary because the proposed ward lacks capacity to make or communicate significant responsible decisions concerning the management of their property? Please explain.
Your answer
Is the Proposed Ward to be moved within the next three days? If yes, where to?
Your answer
Who should be the guardian for the proposed ward?
Your answer
Who should be the conservator for the proposed ward?
Your answer
Do you believe the incapacity of the proposed ward is a permanent or a temporary condition?
Your answer
Does the proposed ward have a living will, durable power of attorney for healthcare, or other instrument that deals with the issue of incapacity?
Your answer
Has the proposed ward nominated anyone to care for the proposed ward in the event of incapacity? If yes, who has been named?
Your answer
Has the proposed ward made any choices regarding end of life care?
Yes
No
Clear selection
Does the proposed ward have a Power of Attorney? If so who?
Your answer
Has anyone been acting on behalf of the proposed ward? If so, who?
Your answer
Please list all property owned by the proposed ward, including real property, cash, savings, automobiles and other assets.
Your answer
Does the proposed ward have any debts? If so, please list.
Your answer
Has there ever been any Department of Family and Child Services or Adult Protective Care Services involvement with the proposed ward? If so, please describe below.
Your answer
Is there anything else you think we need to know?
Your answer
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