Medicaid Forms and Questionnaires

Clients of The Lockwood Legal Group who have employed the firm to represent them in applying for Medicaid or appealing Medicaid denials, should fill out the below questionnaires as completely as possible.

The documents below are password protected. You should have received a password from your attorney. If not, or you have forgotten or lost the password, contact us. We can help.

Other authorization forms such as authorizations for your medical providers to disclose your medical records to your attorney might also become necessary for you to sign.

The HIPA form requires a hand written signature. You can download it here, print it out, and sign it.

If you do not have a printer, let your attorney know and a paper form can be mailed to you.

If you have any questions or concerns, contact your attorney immediately.

Employment Contracts

Medicaid Retainer Agreement

Proof of Representation Agreement


Client General Information Questionnaire

Assets and Finances Questionnaire

Medicaid and/or Social Security Questionnaire