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Wills Package Questionnaire

  • You must be a Virginia resident to qualify for these services.
  • If the service member's spouse wants these services, he or she must fill out a separate questionnaire.
  • You must bring a government issued photo i.d. to the meeting.

Wills Package Questionnaire PDF Version - Click Here

Fill out one of the above, and email or mail it back.

Or fill out the electronic form below and hit submit.



A durable power of attorney allows the agent that you appoint to conduct business and to deal with your money and property on your behalf. You should only select someone you trust. The durable power of attorney does not terminate on your disability, incompetence or incapacity. The power automatically ends on death. A durable power of attorney does not authorize your agent to make health care decisions for you.


A medical directive appoints an individual to act as your agent and to make health care decisions on your behalf. The power granted becomes effective only when you are declared unable to make your own medical decisions. You should appoint someone who will carry out your wishes.


If at any time my attending physician should determine that I have a terminal condition where the application of life-prolonging procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain. In the absence of my ability to give directions regarding the use of such life-prolonging procedures, it is my intention that this declaration shall be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences of such refusal.


Name of the person you would like to appoint as your agent for funeral arrangements and the handling of your remains. This person is usually the same as your agent for health care decisions.


My primary focus is on SMALL BUSINESS LAW. However, I also offer the following services: business consultation, business public speaking & argumentation, Veteran issues, and in some cases traffic & criminal defense.

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Disclaimer: The activities of Juan Vega Law PLLC and personal views of Juan Vega are their own and do not necessarily represent the views of the Marine Corps Reserve, Army Reserve, the Judge Advocate General's Corps, or the Department of Defense.

Office Address
227 South Pollard Street, Suite 209
Vinton, VA 24179