Tell us about you!
Your input will assist us in gaining important insight into your current situation.
Folder Name
Completed Date
-
Month
-
Day
Year
Date
What type of assistance are you seeking?
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Individual
Joint
Business
Institutional
Which of the following are you?
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Attorney
Executive
Tech Professional
Physician
Other
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Age
*
Relationship Status
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Single
Engaged
Separated
Long Term Relationship
Married/Domestic Partnership
Widowed
Financially dependent children
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0
1
2
3
4+
Other financially dependent family members
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0
1
2
3
4+
Partner Name
First Name
Last Name
Partner Email
example@example.com
Are you an entrepreneur, freelancer, or self-employed?
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Yes
No
What is your approximate annual household income?
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under $100,000
$100,000-$249,999
$250,000-$500,000
$500,000-$1 Million
above $1 Million
Please select the value range of your real estate.
*
under $250,000
$250,000-$750,000
$750,000-$1.5 Million
above $1.5 Million
What is the value range of your investments?
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n/a
under $250,000
$250,000-$500,000
$500,000-$1 Million
$1 Million-$3 Million
above $3 Million
What is the value range of your net worth?
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under $250,000
$250,000-$500,000
$500,000-$1 Million
$1 Million-$3 Million
above $3 Million
(Circumstances Permitting) Do you prefer in person meetings or remote video meetings?
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I prefer in person.
I prefer virtual.
No preference.
What areas do you believe you need help with? (select all that apply)
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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?
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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?
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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?
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What do you hope to get out of a financial planning relationship?
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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?
*
LinkedIn
Other Social Media
Personal Referral
Media Appearance
Online Search
Conference or other speaking engagement
Other
Score: Income
Score: Investments
Thank You
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