Personal Financial Snapshot
Now that you've scheduled your financial coaching session, let's start to prepare for our 1st session. Like most things in life, you only get out of it what you put into it. The following questions are meant to give both you and I a snapshot of your financial situation. The more information and detail you can provide in this form prior to our session, the more time we can spend talking about the money management habits that matter the most.
Date
*
-
Month
-
Day
Year
Date
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Birthdate
*
-
Month
-
Day
Year
Date
Occupation
*
Do you have a spouse
*
Please Select
Yes
No
Spouse/Partner Name
First Name
Last Name
Spouse/Partner Email
example@example.com
Spouse/Partner Phone Number
Please enter a valid phone number.
Spouse/Partner Occupation
Spouse/Partner Birthdate
-
Month
-
Day
Year
Date
Preferred method of contact
Phone Call
Text
Email
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred method of meeting
*
In person
Zoom
Phone
Have you ever budgeted before?
*
Yes
No
Your monthly gross income
*
Is your income regular?
*
Please Select
Yes
No
How often do you get paid?
Please Select
Weekly
Bi-Weekly
1st and 15th
Monthly
Spouse/partner monthly gross income
Is your spouse/partner income regular?
*
Please Select
Yes
No
How often does your spouse/partner get paid?
Please Select
Weekly
Bi-Weekly
1st and 15th
Monthly
Do you regualrly budget?
*
Please Select
Yes
No
Do you have any kids or dependents living with you?
Please Select
Yes
No
What are their names and ages?
Taxes
What is the last year you filed your taxes?
Do you owe back taxes?
Yes
No
How much back taxes do you owe?
Savings
Do you have a savings account?
*
Please Select
Yes
No
If yes, how much is in your savings account?
Do you have a retirement account?
Please Select
Yes
No
What is your retirement account balance?
How much are you contributing monthly?
Do you have a non-retirement savings account?
Please Select
Yes
No
What is your non-retirement savings account balance?
How much are you contributing to the account monthly?
Housing
Do you rent or own your home?
*
Please Select
Rent
Own
What is the total monthly payment (including Taxes & Insurance)?
*
Are you current on your payments?
*
Please Select
Yes
No
Vehicles
Do you own any vehicles?
*
Please Select
No
1
2
3
4
5
6
Do you have insurance on all your vehicles?
Please Select
Yes
No
What vehicles do you own?
Do you have any car loans?
Please Select
Yes
No
Are you current on your payments?
Please Select
Yes
No
What is the total monthly payments for all vehicles?
Other Consumer Debt
Do you have any other debt?
*
Please Select
Yes
No
What type of debt do you have?
Credit Card
Home Improvement Store
Student Loan
Taxes
Medical Bills
Peronsal Bank Loan
Other
Why are you here?
What primary issue should we focus on during your coaching session?
*
Budgeting
Debt elimination
Real Estate
Wealth Building/Investing
Other
Please list up to concerns/questions you have regrading the primary issue above.
*
More than just the money!
How do you feel about your current living situation?
I pray it starts every time I get in it
Not ideal but it is functioning
Not the forever home but works for now
Needs so work but nothing major
Love it, this is the forever home
How do you feel about your current vehicle situation?
I pray it starts every time I get in it starts
Not ideal but it is functioning
Could be better could be worse
I'm ok with it for it now
100% satisfied with our vehicle(s)
If you changed nothing, what would the next 3 months look like for you and your family and how would you feel about your money situation?
What do you think is holding you back from achieving your financial goals?
How important is to for you to change your current financial situation?
*
Don't Need Change
1
2
3
4
5
6
7
8
9
100% Change
10
1 is Don't Need Change, 10 is 100% Change
Submit
Should be Empty: