Intake form for free consultation. All information is kept strictly confidential.
Completing this form is the first step of the planning process. Kindly fill this out to the best of your ability as this will help prepare the agenda for your 45-minute consult. If you have questions, or get stuck, reach out to me via email at hello@bewealthycoaching.com. I look forward to helping you with your finances! Meri-Li Forrest
Your Name
*
First Name
Last Name
Your Email
*
Your Year of Birth
*
Your Marital Status
*
Phone Number
*
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse or Partner
Spouse's Name
First Name
Last Name
Spouse's Email
Spouse's Year of Birth
Spouse's Phone
-
Area Code
Phone Number
Income:
Your Occupation
*
Your Gross Income Per Year (before taxes)
*
Your Take Home Pay
Frequency of Your Pay (weekly/2 weeks/monthly)
Spouse's Occupation
Spouse's Gross Income Per Year (before taxes)
Spouse's Take Home Pay
Frequency of Spouse's Pay (weekly/2 weeks/monthly)
Do you receive any additional monthly income?
None
Disability
Government Benefits
Child Support/Alimony
Retirement or Pension
Investment or Rental Income
Other
Total Additional Income Per Month
Housing:
Number of dependents living with you
Housing
*
Own
Rent
Living rent free with family or friends
Mortgage or rent payment
*
Frequency of Payment (monthly, bi-weekly, weekly)
Approximate Value of Home
Approximate Mortgage Balance
Financial Information:
Amount of Car Payment #1
Car Payment #1 Frequency
Approximate Total Owed
Amount of Car Payment #2
Car Payment #2 Frequency
Approximate Total Owed
Approximate Total Value of All Other Debts (credit card, line of credit, student loans, etc)
Total Value of RRSP's
Total Value of TFSA's
Total Value of Pensions
Total Value of RESP's
Total Value of Other Investment Accounts/Cottage/Rentals/Land?
How much do you save for retirement per year (including Employer contributions, Pensions, RRSPs)?
How much are you saving in other investments per year?
How much are you saving for children's education per year?
Do you have Life Insurance (type/amounts)?
Do you have updated Will(s)?
Did you receive a tax refund last year? If yes, how much?
Do you have a working monthly budget?
Do you track your monthly expenses (how)?
Your Financial Priorities:
In order to best customize our agenda to meet your needs, choose 3 topics that are most important to you at this time:
Developing a Cash Flow Plan (Budget)
Educating Yourself on Financial Matters
Retirement Planning
Establishing an Emergency Fund
Eliminating Personal Debt
Understanding Low Cost Investing
Investment Portfolio Review
Estate Planning
Forming Good Money Habits for Children
Real Estate (buying/selling)
Appropriate Insurance Coverage
Increasing Savings Levels and Building Net Worth
Transitioning to Self-Employment or Entrepreneurship
Creating a Plan to Accomplish a Large Goal (e.g., Renovation, Major Purchase)
Other
Ona scale of 1-5, how confident do you feel with your overall finances right now?
1
2
3
4
5
Not confident at all
Very confident, but looking for more strategy and a plan
1 is Not confident at all, 5 is Very confident, but looking for more strategy and a plan
On a scale of 1-5, how confident do you feel with your investing knowledge and strategy?
1
2
3
4
5
Not confident at all
Very confident
1 is Not confident at all, 5 is Very confident
What prompted you to reach out and book this meeting?
Use this space for additional information you would like to share that wasn't captured in the questions above.
Thanks for completing this intake form. I look forward to our session.
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