Physical Therapy Incorporation Questionnaire

Client Information

1. Contact Information– Please provide your contact information. While we more than likely already have this information on file, this will provide you with an opportunity to provide us with any updated information. It will also ensure that your incorporation questionnaire is filed properly. Finally, please indicate whether you will be serving as the corporation’s incorporator. If not you, then it will be the initial Board of Directors, requiring all directors to sign the articles of incorporation.

   Client name:

   Street Address:

   City:

   County:

   State:

   Zip Code:

   Email Address:

   Home Phone Number:

   Facsimile Number:

   Mobile Phone Number:

   Will be serving as the Incorporator:YesNo

   
   

Entity Information

2. Convert or Create – Please let us know if you plan to convert an existing business (sole proprietorship, partnership, LLC, out-of-state corporation, etc.) into a California corporation or if you are creating a completely new corporation from scratch. By converting an existing business, you are indicating that you plan for your corporation to assume the owners, clients, accounts receivable, assets, and liabilities of the current business.

   
   

   Converting an Existing Business:YesNo

   Creating a New Corporation:YesNo

   
   

   If creating a new corporation, please skip to item 3 “Name Choice”. If converting a business, please complete the following additional questions:

   
   

   Current Business’s Name:

   Type of Entity:

   Original Formation Date:

   Estimated Assets:

   Estimated Liabilities:

   Estimated Fair Market Value:

   
   

3. Name Choice – Please provide your top three preferred name choices. To see if a name is available, please check the Secretary of State website at http://kepler.sos.ca.gov/cbs.aspx.

   Please remember to include the required professional language (i.e. Physical
   Therapist, Physical Therapy) and incorporation language (i.e. Corporation,
   Incorporated, Limited, Corp., Inc., Ltd., etc.¹) If you would like us to reserve your name in advance of incorporation, please so indicate.
   

   Preferred Corporate Name #1:

   Preferred Corporate Name #2:

   Preferred Corporate Name #3:

   Do you want your name reserved?²:YesNo

   Do you want a separate, fictitious trade name?³:YesNo

   Preferred Fictitious Trade Name:

   ¹Physical Therapy Limited Liability Companies are illegal in the state of California. This was the result of California Attorney General Opinion No. 04-103.

   ²By selecting this option, it confirms the name’s availability and reserves the name for 60-days. We will file the request in person and it usually takes the Secretary of State’s office 2-3 days to process the request. The only downside is that we must wait for the Secretary of State to indicate which name has been reserved, to place it onto the Articles of Incorporation at the time of filing.

   ³Some businesses prefer to acquire the local rights to acronyms or shortened versions of their corporation’s name. Please so indicate so that we can properly acquire.

   
   
   

4. Corporation Contact Information – Please provide the anticipated principal business address and contact information for the corporation. This is the (anticipated) physical address of the corporation. Therefore, a P.O. Box address is not sufficient. Rather, if applicable, add the mailing address at the bottom.

   
   

   Street Address:

   City:

   County:

   State:

   Zip Code:

   Email Address:

   Website Address:

   Office Phone Number:

   Office Facsimile Number:

   Office Mobile Phone Number:

   Separate Mailing Address?:YesNo

   City:

   State:

   Zip Code:

   
   

5. Primary business activity – You contacted our office in order to incorporate a physical therapy business. As a result, we are pursuing this incorporation with the understanding that its primary business activity will be providing physical therapy services. If we are mistaken, please contact our office immediately.

   In addition, please answer the following question.

   
   

   Will you be employing medical doctors or osteopaths? :YesNo




6. Business/Fiscal Year – A corporation can typically choose when to begin and end its business or fiscal year. The date of incorporation is the date the articles are received by the Secretary of State, unless indicated otherwise below⁴. For most corporations (and particularly corporations electing S-corporation status), the end of the year is December 31.
   

   Desired Date of Incorporation:

   End of Business/Fiscal Year?

   ⁴The Secretary of State will hold the articles and file them on a specified date – including weekend or holiday – up to 90 days in the future.




7. Matters Requiring Articles to be Effective - Some optional provisions for the corporation must be expressly treated in the articles of incorporation to be effective. In the absence of a provision in the articles, mere treatment of a matter in a bylaw or resolution of the shareholders or the directors will be ineffective. Please note that if any of the below are selected, additional information may be requested from our office.