Moton Financial Coaching
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Age
Marital Status
Single
Married
Divorced
Widowed
What is your Annual Income?
0-$20,000
$21,000-$40,000
$41,000-$60,000
$70,000 or Above
Do you work with a financial planner?
Yes
No
Do you work with an accountant?
Yes
No
Do you know your monthly expenses?
Yes
No
Do you know your total debt?
Yes
No
Dont have any debt
Check all the places where you owe money(Check all that apply)
Credit card
Car loan
Student loan
Personal loan
Business loan
Collections
Unpaid Medical
Other
None
What do you think prevents you from having more financial security?
What is the hardest thing for you when dealing with money?(Check all that apply)
Shopping
Over-spending
Earning
No Planning
How do you see your financial future?
Check all the places where you keep money(Check all that apply)
Cash
Checking
Savings
Investments
Other
I am here because I want to(Check all that apply):
Create a spending plan or budget
Reduce spending and bills
Reduce my debt
Open a High Yield Savings Account
Save for emergencies
Save for a goal
Other
Do you currently have a personal budget, spending plan, or financial plan?
Yes
No
How confident are you in your ability to achieve a financial goal you set?
Not at all confident
Somewhat confident
Very confident
If you had an unexpected expense or lost your job, got sick to the point you were unable to work. How confident are you that your family could come up with money to make ends meet for at least 3 months?
Not at all confident
Somewhat confident
Very confident
Do you currently have an automatic deposit or electronic transfer set up to put money away for future use?
Yes
No
What would you like to get out of Financial Coaching?
Submit
Should be Empty: