basic continuity plan
BASIC CONTINUITY PLAN
Personal & Professional Information
Full Legal Name
Preferred Name
Email Address
Phone Number
State of Residence
State of Residence
England
Scotland
Wales
Northern Ireland
Profession / License Type
State(s) of Licensure
Practice Information
01
Current Practice Status
Actively practicing
Retired
Temporarily inactive
02
Practice Type
Solo practice
Group practice
Organization / Institution
03
Approximate Number of Active Clients
1–25
26–75
76–150
150+
Existing Planning (High-Level)
01
Do you currently have a will?
Yes
No
Unsure
02
Do you have any form of continuity or succession plan?
Yes
No
03
Have you identified a successor or responsible party?
Yes
No
Continuity Intent
01
Primary Goal of This Plan
Emergency continuity
Temporary coverage
Planned transition
02
When should this plan take effect?
Death
Incapacity
Emergency
Planned absence
Confirmation & Next Steps
01
Confirmation
I confirm that the information provided is accurate to the best of my knowledge.
02
Consent
I consent to the secure storage and review of this information for continuity planning purposes.
03
Follow-Up Contact
I would like to be contacted to discuss next steps.
Schedule a Review
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