Financial Wellness Assessment
Virtuosity Financial Services, LLC
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
What topics regarding personal finances are of interest to you? (Select all that apply)
Developing a Monthly Plan for Success
Budgeting & Planning for Emergencies
Tackling Debt
Relationships and Money
Kids and Money
Saving for College Tuition
Retirement Planning
Investing
Credit
Other
What is your total monthly income?
What is your total for monthly expenses?
How much do you have in emergency savings?
Are you completely at peace about your financial future?
Yes
No
Do you do a monthly written budget every single month?
Yes
No
Would you say you live paycheck to paycheck most months of the year?
Yes
No
Have you ever borrowed money from a friend or relative?
Yes
No
Have you ever borrowed from your retirement plan?
Yes
No
Have you ever lost sleep due to financial stress?
Yes
No
Which of the following best describes your current, monthly cash flow situation?
Can't pay all my bills and fall behind further each month
Can pay all my bills, but things are really tight
Pay my bills and have some money left over
What learning style would you be likely to participate in? (Check all that apply)
Live Workshops
Online Resources
One-on-One Coaching
Appointment - Please give the best date and time for initial consultation
Submit
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