Preliminary Questionnaire

Folder Name

Completed Date

Date

Are you an individual or a joint couple seeking assistance? *

Individual Joint

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Age *

Relationship Status *

Single Long Term Relationship Engaged Married / Domestic Partnership Separated Widowed

Partner Name

First Name Last Name

Partner Email

example@example.com

Are you an entrepreneur, freelancer, or self-employed? *

Yes No

What is your approximate annual income? *

How would you describe the stage of investing that you are currently in? *

I am paying down debt and getting information. I am an early stage investor needing guidance around what types of accounts I should be saving in and how much. I am mid-career and my finances are becoming more complicated. I am seeking help to make sure I am on the right track. I am within 5-10 years away from retirement and I need to make sure I have a plan for taking income in retirement and not outliving my assets. I am already retired.

(Circumstances Permitting) Do you prefer in person meetings or remote video meetings? *

I prefer in person. I prefer virtual. No preference.

What areas do you believe you need help with? (select all that apply) *

I want information about 529 college plans. I want information on life insurance or Long Term Care. I want to focus on Retirement Savings and review of my investments. I want to invest outside of my retirement. I am a business owner and want information on how to save for retirement through my business. I have old retirement accounts that I need help consolidating.

How many year have you been saving for retirement? *

1-5 years 6-10 years 11 - 20 years 21+ years

Are you interested in any of the following? (check all that apply)

Faith based investments Environmentally conscious Investments and/or Socially conscious Investments No preference Other

What is prompting you to seek out a financial advisor right now? *

What do you hope to get out of a financial planning relationship? *

What are your biggest dreams you have for your life, and how might I help you achieve them? *

Think really big here. Like "money is no object" big.

Is there anything else you feel we should know about you?

Where did you hear about me? *

Social Media Referral from Friend Referral from Coworker Publication Media Appearance Online Search Conference or other speaking engagement Other

Score

Thank You

Next Step

Reminder Date

Tell us about you!