FINANCIAL HEALTH QUESTIONNAIRE?

Are you Financial Healthy?
FINANCIAL HEALTH CHALLENGE
Name

First NameLast Name
Sex:*

MaleFemale
Age Range*

20-3030-4040-5050-60Other
If you died today, would your family financial LIFESTYLE change for the better? (i.e. enough life insurance to replace your income)*

YesNo
Can you get your hands on $1000 within 24 hours without borrowing?*

YesNo
If you lost your job can you survive at least 6 months without touching your Job Retirement Account? (Retirees can skip this question)

YesNo
Do you have $500 cash in a secured place in your home?*

YesNo
Do you give to people or organizations on a regular?*

YesNo
Do you vacation at least twice per year?*

YesNo
How do you feel about your credit/ and or creditor?*

1

2

3

4

5

1 is Responsible, 5 is Scared
How much influence does family and / or friends have on your financial decisions?*

1

2

3

4

5

1 is Responsible , 5 is Scared
IF YOU CIRCLED YES OR 1 TO ALL THE QUESTION, YOU ARE HEALTHY!

If you answered 3 or 4 No's then you need assistant to help you create a Financial plan that will set you up for Financial Freedom.
Signature*

Clear
Should be Empty: