Re-Envision Wealth Preliminary Questionnaire

Tell us about you!

Your input will assist us in gaining important insight into your current situation.
Folder Name
Completed Date

MonthDayYear
Date
What type of assistance are you seeking?*

IndividualJointBusinessInstitutional
Which of the following are you?*

AttorneyExecutiveTech ProfessionalPhysicianOther
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Age*
In which state do you reside?*
Relationship Status*

SingleEngagedSeparatedLong Term RelationshipMarried/Domestic PartnershipWidowed
Financially dependent children*

01234+
Other financially dependent family members*

01234+
Partner Name

First NameLast Name
Partner Email
example@example.com
Are you an entrepreneur, freelancer, or self-employed?*

YesNo
What is your approximate annual household income?*

under $100,000$100,000-$249,999$250,000-$500,000$500,000-$1 Millionabove $1 Million
Please select the value range of your real estate.*

under $250,000$250,000-$750,000$750,000-$1.5 Millionabove $1.5 Million
What is the value range of your investments?*

n/aunder $250,000$250,000-$500,000$500,000-$1 Million$1 Million-$3 Millionabove $3 Million
What is the value range of your net worth?*

under $250,000$250,000-$500,000$500,000-$1 Million$1 Million-$3 Millionabove $3 Million
(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 align my portfolio with my values.I am a business owner and want information on how to save for retirement through my business.I have old retirement account that I need help consolidating.
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.
How many years have you been investing?*

1-5 years6-10 years11 - 20 years21+ years
Are you interested in any of the following? (check all that apply)

Faith based investmentsEnvironmentally conscious Investments and/or Socially conscious InvestmentsNo preferenceOther
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 we help you achieve them?
Is there anything else you feel we should know about you?
Where did you hear about us?*

LinkedInOther Social MediaPersonal ReferralMedia AppearanceOnline SearchConference or other speaking engagementOther
What is the name of your Personal Referral, and what is their relationship to you?*
Score: Income
Score: Investments
Thank You
Next Step
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Tell us about you!