ME Shield
ME Shield Financial ServicesSECURE CLIENT INTAKEFÒM KLIYAN AN SEKIRITE
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SECURE CLIENT INTAKEENFÒMASYON KLIYAN AN SEKIRITE

One complete intake.
Better preparation.Yon sèl fòm konplè.
Pi bon preparasyon.

Choose your service and complete only the questions that apply. Social Security numbers, banking details, payment cards, passwords, passport numbers, and Medicare numbers are never requested here.Chwazi sèvis ou a epi reponn sèlman kesyon ki aplike pou ou. Nou pa janm mande nimewo Sekirite Sosyal, detay bankè, kat peman, modpas, nimewo paspò, oswa nimewo Medicare isit la.

No portal login requiredOu pa bezwen konekte nan pòtay la Your submission goes through a protected, write-only intake endpoint and is held for staff review before it can be linked to a portal record.Soumisyon ou pase nan yon chemen pwoteje ki sèlman resevwa nouvo fòm, epi ekip la dwe verifye li anvan li ka lye ak yon dosye nan pòtay la.
DETAILED INTAKE VERSIONVÈSYON ENFÒMASYON DETAYE
START HEREKÒMANSE ISIT LA

What can we help you protect?Kisa nou ka ede ou pwoteje?

Select one option. The questions ahead will adapt to your choice.Chwazi yon opsyon. Kesyon ki vin apre yo ap adapte selon chwa ou.

Would rather not fill this out alone?Ou pito pa ranpli l pou kont ou?

Call or message us and a team member will complete this intake with you over the phone — nothing about the online form is required.Rele oswa voye yon mesaj — yon manm ekip la ap ranpli fòm sa a avèk ou nan telefòn. Ou pa oblije itilize fòm sou entènèt la.

Call (407) 267-2652Rele (407) 267-2652 Message on WhatsAppMesaje sou WhatsApp

A little about youEnfòmasyon sou ou

This identifies your request and lets our team contact you. No portal account is required.Sa idantifye demann ou epi li pèmèt ekip nou an kontakte ou. Ou pa bezwen kont pòtay.

Service detailsDetay sèvis

These questions are specific to the service you selected.Kesyon sa yo espesifik a sèvis ou chwazi a.

A few more detailsKèk lòt detay

The questions that decide the price. Most are a single tap.Kesyon ki deside pri a. Pifò se yon sèl tap.

OPTIONALOPSYONÈL

DocumentsDokiman

Attach anything that helps us prepare — a current policy declarations page, proof of prior coverage, or similar. You can skip this and send documents later.Tache tout sa ki ka ede nou prepare — yon paj deklarasyon polis aktyèl, prèv ansyen kouvèti, oswa bagay similè. Ou ka sote etap sa a epi voye dokiman yo pita.

Suggested document checklistLis dokiman nou sijere

Check what you plan to provide. You may edit, remove, or add an item.Tcheke sa ou planifye bay. Ou ka modifye, retire, oswa ajoute yon dokiman.

Attach photos, PDFs, or documentsTache foto, PDF, oswa dokiman
Up to 3 files, 5MB each. No passwords, banking details, or full card numbers in any attachment.Jiska 3 fichye, 5MB chak. Pa mete modpas, detay bankè, oswa nimewo kat konplè nan okenn atachman.
Nothing to attach right now? Just click Continue — you can email or text documents to us anytime.Ou pa gen anyen pou tache kounye a? Klike sou Kontinye — ou ka voye dokiman ba nou pa imèl oswa tèks nenpòt lè.
CHECK YOUR ANSWERSVERIFYE REPONS OU YO

Review before submittingRevize anvan ou soumèt

Confirm the information below. Use Edit to return to a section.Konfime enfòmasyon anba yo. Itilize Modifye pou retounen nan yon seksyon.

FINAL STEPDENYE ETAP

Signature & consentSiyati & konsantman

Please confirm the statements below to submit your intake.Tanpri konfime deklarasyon anba yo pou soumèt fòm ou.

Client signature *Siyati kliyan *
Your submission records the signature time and, only if you allow it, an approximate location.Soumisyon an anrejistre lè siyati a epi, sèlman si ou pèmèt li, yon pozisyon apwoksimatif.

Keep your case organized in one secure place.Kenbe dosye ou òganize nan yon sèl kote ki an sekirite.
Create your Client Portal account to follow updates, view documents, and receive invoices. We will email you how to sign in—no password required.Kreye kont Client Portal ou pou swiv mizajou, wè dokiman, epi resevwa fakti. N ap voye nan imel ou kijan pou w konekte—ou pa bezwen modpas.