Consultation Intake Form

1
Name* This field is required.
First Name
Last Name
2
Age* This field is required.
3
Primary Personal Email Address* This field is required.
example@example.com
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Do you have a spouse or life partner that you plan your financial future with?* This field is required.
YESNO
6
Spouse or Partner's Name
First Name
Last Name
7
Spouse or Partner's Age
8
Spouse or Partner's Primary Personal Email
example@example.com
9
On a scale of 1-10, how "in control" do you feel over your cash flow?A "1" would indicate that you don't track your spending in any formal way, you don't pay close attention to how your money is spent, and you feel stress about spending money. A "10" would indicate that you have a budget (and probably use a budgeting app), you track your spending carefully, you can easily calculate how much money you spend each month, and you feel very much in control of your spending and cash flow.
10
On a scale of 1-10, how comfortable do you feel with investing?A "1" would indicate that you have no experience with investing and might even feel uncomfortable with the stock market. A "10" would indicate that you are very familiar with investing and you know a lot about the different types of retirement/investment accounts, you are familiar with asset allocation, and you are familiar with mutual funds and ETFs.
11
On a scale of 1-10, how up to date is your estate planA "1" would indicate that you don't have a will or trust in place, you don't have POA, HIPAA, or Living Will documents, and have not reviewed your financial account beneficiaries recently. A "10" would indicate that you have a complete and up-to-date set of estate documents and you have reviewed your beneficiaries recently.
12
On a scale of 1-10, how confident do you feel about your insurance coverage?A "1" would indicate that you are not sure how much life insurance you need and may not have enough coverage, and you don't have disability insurance in place. A "10" would indicate that you have the proper amount of life insurance and disability insurance as appropriate in your household, as well as other types of insurance as needed. You feel prepared for any events that could interrupt income in your household.
13
On a scale of 1-10, how confident do you feel about your cash situation?A "1" would indicate that you don't have an emergency fund and would not be able to cover any large unexpected expense. A "10" would indicate that you have a fully funded emergency fund (at least 6 months of expenses saved up) and would be able to cover large unexpected expenses without going into debt.
14
What is your annual household income?* This field is required.If you have a spouse or partner, please choose the range that best represents your COMBINED income.
< $50,000
$50,000 - $100,000
$100,000 - $150,000
$150,000 - $200,000
$200,000 - $250,000
$250,000 - $300,000
$300,000 - $350,000
$350,000+
15
How much debt do you have (not counting a mortgage)* This field is required.Include all credit card debt, car loans, student loans, HELOCs, IRS debt, medical debt, and other loans. If you have a spouse or partner please select the range which reflects your COMBINED debt.
$0 - $25,000
$25,000 - $50,000
$50,000 - $100,000
$100,000 - $150,000
$150,000 - $200,000
$200,000 - $250,000
$250,000 - $300,000
$300,000+
16
How much does your household have on hand in cash accounts (checking, savings)?* This field is required.If you have a spouse or partner, please select a range that reflects your COMBINED cash on hand.
$0 - $1,000
$1,000 - $5,000
$5,000 - $10,000
$10,000 - $15,000
$15,000 - $20,000
$20,000 - $25,000
$25,000 - $50,000
$50,000 - $100,000
$100,000 - $300,000
$300,000 - $500,000
$500,000 - $1M
$1M+
17
How much does your household have in investments that are in a current 401(k) or retirement plan at a current job?* This field is required.This includes employer retirement accounts from your CURRENT job (if applicable). If you have a spouse or partner, please select a range that reflects your COMBINED retirement account balance.
$0 - $25,000
$25,000 - $50,000
$50,000 - $100,000
$100,000 - $200,000
$200,000 - $300,000
$300,000 - $400,000
$400,000 - $500,000
$500,000 - $750,000
$750,000 - $1M
$1M - $2M
$2M - $3M
$3M - $5M
$5M - $10M
$10M+
18
How much does your household have in investments that are in IRAs, brokerage accounts, or old 401(k)s from previous jobs?* This field is required.This includes IRAs, Roth IRAs, OLD employer retirement accounts, brokerage accounts, and other investment accounts. If you have a spouse or partner, please select a range that reflects your COMBINED account balance.
$0 - $25,000
$25,000 - $50,000
$50,000 - $100,000
$100,000 - $200,000
$200,000 - $300,000
$300,000 - $400,000
$400,000 - $500,000
$500,000 - $750,000
$750,000 - $1M
$1M - $2M
$2M - $3M
$3M - $5M
$5M - $10M
$10M+
19
How do you currently file your taxes?* This field is required.
I do my own taxes through a tool like TurboTax, etc.
I have a tax professional that does my taxes
I don't currently have someone to do my taxes (or I'm not happy with my tax pro) and I would like to find someone
20
What are the top 2-3 questions or concerns about money that are top of mind for you right now?
1
2
3
21
In general, what has prompted you to consider working with a financial advisor?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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