FINANCIAL WELLBEING QUESTIONNAIRE
Name
*
Full Name
Date Of Birth
*
/
Day
/
Month
Year
DD/MM/YYYY
Phone Number
*
Email
*
example@example.com
Section 1: Income and Employment
What is your primary source of income?
*
Employment
Self-Employment
Investments
Other
How satisfied are you with your current income level?
*
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat DIssatisfied
Very Dissatisfied
Section 2: Budgeting and Spending
Do you have a monthly budget?
*
Yes
No
How often do you track your spending?
*
Daily
Weekly
Monthly
Rarely
Never
On a scale of 1-5, how confident are in managing your monthly expenses?
*
1 (Not Confident)
2
3
4
5 (Very Confident)
Section 3: Savings and Emergency Funds
Do you have a dedicated emergency fund?
*
Yes
No
If Yes, how many months of living expenses do you have saved?
1 Month
3 Months
6 Months
More than 6 Months
How often do you save money each month?
*
Always
Often
Sometimes
Rarely
Never
Section 4: Debt Management
Do you currently have any debt?
*
Yes
No
If yes, what type of debt do you have? (Select all that apply)
Credit Card Debt
Student Loans
Personal Loans
Mortgage
Other
On a scale of 1-5, how stressed do you feel about your debt?
*
1 (Not Stressed)
2
3
4
5 (Very Stressed)
Section 5: Financial Protection
Do you currently have Financial Protection in place?
*
Yes
No
If yes, what type do you have? (Select all that apply)
Life Insurance
Whole of Life Insurance
Critical Illness
Income Protection
Private Medical Insurance
I Don't Know
Other
When did you last review your protection?
*
Within the last 12 months
1-3 Years
3-5 years
5+ Years
Never
Don't have any
What areas of your financial wellbeing would you like to improve? (Select all that apply)
*
Budgeting
Saving
Protection
Debt Management
Investments
Retirement Planning
Other
Would you be interesting in a Personal and/or Business Financial Audit (Paid for) that includes a FREE Protection Review?
*
Yes
No
I would like more information
Save
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