Aaron Herbert Wrongful Death and Family Support Center
Confidential questionnaire for wrongful death family members
A printable form to help your family organize what you need before you talk with us. Fill in only what you can.
You do not need to finish this questionnaire before asking for a free case review. Each family member can fill out a separate copy.
Before you fill it in
| Please | Why |
|---|---|
| Do not email it or upload it anywhere. | Call us first and we will tell you our private way to return it, or bring it to your case review. |
| Leave out Social Security numbers, account numbers and passwords. | We do not need them at this stage. |
| Skip anything you would rather talk about in person. | "Not sure" is always a fine answer. |
| Do not include therapy records or graphic details. | A referral can be arranged without them. |
| Never post a completed form on social media. | It contains private family information. |
The word "confidential" does not guarantee attorney-client privilege for everything on the form, and sending it does not by itself make you a client. Ask us about privacy before you share sensitive information.
What the questionnaire covers
| Section | Examples |
|---|---|
| 1. Today's priorities | A safe place tonight, food, medicine, rent, rides, childcare, funeral plans. |
| 2. How to reach you | Call, text or email; whether voicemail is safe; language and accessibility needs. |
| 3. What happened | The date, place and type of incident, agencies involved, any report number. |
| 4. Family and dependents | The spouse, children and parents, and anyone who relied on your loved one for income or care. |
| 5. Housing and household money | Notices, bills due in 7 and 30 days, income that stopped. |
| 6. Rides and caregiving | Vehicle access, school transportation, care for an older parent or a person with a disability. |
| 7. Emotional support | Whether information about grief support would help, and what kind. |
| 8. Funeral and belongings | Funeral provider, cost concerns, cultural practices, death certificates. |
| 9. Benefits, estate and evidence | Insurance, Social Security, a will, photos or video, any request to sign a release. |
| 10. Privacy and next steps | Unwanted calls or media, and who may receive updates. |
Not an emergency service
This form is not monitored around the clock. If anyone is in danger, call 911. For thoughts of suicide or overwhelming distress, call or text 988.
Guide
Surviving family needs assessment
The same twelve areas explained, with an example of how a family's priorities change week to week.
Open the needs assessment →Family Support Center
Grief programs and practical help
Crisis lines, Dallas–Fort Worth grief programs, funeral help and survivor benefits.
Visit the Family Support Center →Talk with us first
Call The Law Firm of Aaron A. Herbert, P.C. at 214-200-4878 or 817-500-4878. We will explain how to return the questionnaire privately, or go through it with you by phone.
General information only. Completing the questionnaire does not create an attorney-client relationship.