Blue Mountain Wealth Management Financial Planning Intake Form
Congratulations on wanting to complete a comprehensive financial plan! This is a great first step to understanding where you are (financially) and where you want/need to get to. This form will gather all the information we need to start the planning process and get you on track to becoming financially independent!
Let's start with the basics...
Name
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
Employment Status
Occupation
Annual Income
Other Income
State of Residence?
Are you married?
Yes
No
Tax Filing Status?
Married filing Jointly
Married Filing Seperatly
Single
Head of Household
Please upload a copy of your latest tax return(s).
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Do you have kids?
Yes
No
Yes, but they are grown and don't need to be included in the plan.
What's Important about Money to You?
It is important for us to understand your goals and values surrounding money. Give these questions a shot for us, please...
Imagine you have enough money to satisfy all of your needs, both now and in the future. Would you change your life and, if so, how would you change it?
You are back in your current financial situation. Your doctor tells you that you have 5 to 10 years to live, and you will feel fine up until the end. Would you change your life and, if so, how would you change it?
Imagine that your doctor tells you that you have just one day to live. You look back on your life and ask what did you fail to experience, who is the person that you did not become, and what did you neglect to do?
What is the best investment you have ever made?
What is the worst investment you have ever made?
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Goals
Goals can be subjective and will most likely change over time. Give us your current thoughts on some basic goals as a starting framework...
At what age would you like to retire, or become financially independent (work optional)?
How much money (take home, in your pocket, after-tax) would you like to have per month (in today's dollars) in retirement?
Do you plan to move to another state or country in Retirement? If so, what state or country would you move to?
Do you think you will have any supplemental income in retirement, like part-time work? If so, please describe where you envision this income would come from and how much you think it would be.
How do you envision retirement? The more detail you can provide, the better...
Do you want to provide for your children's (or grandchildren's) education (or other financial goal someday? Tell us about it...
Tell us about any other goals you may have? (buying a second home, daughters wedding, purchasing a business, world travel, RV, etc.)...
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Social Security Benefits
If available, provide your Social Security estimates from ssa.gov
Have your Social Security Benefits already started?
Yes
No
I am not sure
Please upload a copy of your Social Security Statement(s) from ssa.gov
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Investments
Identify all the resources that you have to fund your goals. Don't worry about determining the exact amounts, reasonable estimates are fine here. If available, provide your investment statements by uploading them below. If you are able to upload your statements, there is no need to fill in this section.
Upload Investment Statements here
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Type a question
Current Value
Annual Additions
Retirement Plans (e.g., 401k, 403b)
Traditional IRA
Roth IRA
529 Savings Plan
Annuities
HSA
Taxable / Brockerage
Other
Do you have access to a retirement plan (like a 401(k) at work)?
Yes
No
Not Sure
Any other information you would like to share about your investments, or other investments not captured by the chart above you would like to share (workplace stock plan, long-term incentives, bonuses, etc.)...
Upload your workplace retirement statement(s) here.
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Do you own a home? Tell us about it (value, mortgage details, payments, are you trying to accelerate the payoff, how long have you lived here, do you plan to sell or move, etc.)...
You can upload your mortgage statement here...
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Tell us about any other major debt you have (2nd mortgage, car loans, credit cards, student loans, etc.)...
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Concerns
Any other concerns you want to share?
Type a question
Check
Degree
Not having a paycheck anymore
Yes
No
Running out of money
Yes
No
Suffering investment losses
Yes
No
Leaving money to others
Yes
No
Spending too much
Yes
No
Cost of health care or long-term care
Yes
No
Curent or future health issues
Yes
No
Dying early
Yes
No
Living too long
Yes
No
Getting Alzheimer's (or other illness)
Yes
No
Going into a nursing home
Yes
No
Being bored
Yes
No
Too much time together
Yes
No
Parents needing care
Yes
No
Family needs financial help
Yes
No
Kids moving home
Yes
No
Care for child with special needs
Yes
No
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Retirement Income
Tell us about any retirement income you expect to receive other than your Social Security or investment income (Pensions, part-time work, rental properties, annuities, royalties, alimony, etc.).
Type a question
Description of Income
Monthly Income
Start Year
End Year
1
2
3
4
5
6
7
8
9
10
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Extra Savings
Enter the maximum additional amount you could save each year above your existing annual savings:
How willing are you to save more?
Not at all
Slightly
Somewhat
Very
Insurance(s)
Do you have any life insurance?
Yes
No
Maybe
If you have life insurance, please tell us about any policies you have. (type, cost, when they started, if they end at a certain date, cash value (if any), how much insurance, etc).
Tell us about any disability insurance policies you (or co-client) own?
Tell us about any Long Term Care insurance you (or co-client) own?
Upload any insurance statements you have here...
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Some other questions...
Do you smoke?
Yes
No
Occasionally
Used to but not anymore
How is your health (generally)?
Above Average
Average
Below Average
Might you become financially responsible for aging parents?
Do you have a Will and/or Trust?
Yes, my estate planning is in order
Yes, but my estate documents need to be updated
No, but I have been thinking about this
No, I am not even sure where to start
Is leaving a legacy important to you? Tell us about who you want to take care of once you have passed...
Anything else you would like us to know about or to consider in your plan?
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