Personal Financial Snapshot
This form should give me everything I need to know in order to help you take the next step on your journey to greater financial wellness. Please fill it out to the best of your knowledge. Don't be overwhelmed or worry about getting everything perfect at this point! I look forward to helping you! -- DJ Smith, Evergreen Oasis
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Occupation
What is your total monthly take home income?
Spouses Name (if applicable)
First Name
Last Name
Spouse's Occupation
What is your spouse's total monthly take home income ?
Number of children or other dependents
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have an irregular income?
Yes
No
Do you keep a budget?
Yes
No
Sometimes
Do you have an emergency fund?
Yes
No
How much do you have in your emergency fund?
Do you have other savings?
Yes
No
How much do you have in other savings?
Are you currently investing for retirement?
Yes
No
What is your monthly contribution to retirement?
What is your balance in retirement?
Do you rent or own?
Rent
Own
Other
How much are your monthly payments for this?
Do you have car payments? If so, how many vehicles do you owe money on?
No car payments
1 vehicle
2 vehicles
3 or more vehicles
How much are your total monthly payments on vehicles?
If you have credit card debt, how much total do you owe?
If you have student loan debt, how much total do you owe?
If you owe money on taxes, how much do you owe?
If you have other kinds of debt, how much do you owe?
In your own words, explain your financial situation. Whatever you would like to share, whether your hopes for the future, concerns, etc. Please also include what would be important to you for us to cover as we meet.
Select which option you would prefer for our follow up (a 15-20 minute call): ***Note if you are married, I would love to talk with you and your spouse together.
Phone Call
Video Call
Submit Survey
Should be Empty: