NAME
Email
example@example.com
Mobile Phone
Please enter a valid phone number.
What is your preferred method of contact?
Please Select
Email
Phone
No preference
What is the best time to contact you?
Please Select
Early morning
Early afternoon
Late afternoon
Do we have your permission to text you?
Yes
No
What do I most like about my current financial status?
What do I least like about my current financial status?
These are my good financial habits.
How do I get back on track when my good financial habits lapse?
I know how much money/debt I owe.
Yes
No
I have a goal to set aside money to create an emergency fund.
Yes
No
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I often ask myself: Do I need this, or do I just want this?
I put money into savings before I spend it on other things.
I am willing (and ready) to say, “No, I can’t afford to do that.
Submit
Should be Empty: