Financial Guidance Intake Form

Financial Guidance Intake Form
Please Read Before Completing

Please complete this intake form at least 24 hours before your scheduled session. Answer each section as thoroughly as possible so we can better understand your goals, current financial situation, and the areas where you need the most support. If a question does not apply to you, you may write N/A. All information shared is used to help prepare for your session and provide more personalized financial guidance.
Client Information
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
City/State:
Occupation/Industry:
Preferred Contact Method*

PhoneE-MailText
Marital Status:
Number of Dependents:
Service(s) Requested
*

Budget & Cash Flow PlanningDebt Payoff StrategySavings & Emergency Fund PlanningTax-Smart Financial GuidanceRetirement Contribution GuidanceW-4 Withholding ReviewSelf-Employed Income PlanningCredit & Financial ReadinessCredit Improvement GuidanceHomebuying Financial PreparationSmall Business Financial GuidanceMonthly Accountability & Support
Emergency fund available?

YesNoWorking on it
Do you currently have debt?

YesNo
Primary Goals

What are your top 3 financial goals right now?
1.
2.
3.
What would a successful outcome from this session look like for you?
Current Financial Snapshot
Estimated Monthly Household Income:
Estimated Monthly Household Expenses:
Do you currently follow a budget?*

YesNoSomewhat
Current Savings amount (optional):
Emergency fund available?*

YesNoWorking on it
Do you currently have debt?*

YesNo
Debt - If yes, please check all that apply:

Credit cardsStudent loansAuto loansPersonal loansMedical debtMortgageTax debtOther
Estimated total debt (optional):
Credit & Homebuying Readiness
Credit Report can be accessed weekly via:

https://www.annualcreditreport.com/index.action
Have you reviewed your credit recently?

YesNo
Estimated credit score range (optional):

740+680-739620-679580-619Below 580
Are you planning to buy a home in the next 12 months?

YesNoMaybe
Are you currently working on improving your debt-to-income ratio?

YesNo
Tax-Smart Financial Guidance
Employment Type

W-2 EmployeeSelf-EmployedBusiness OwnerContractor / 1099Multiple Income Sources
Do you need help with any of the following?

W-4 withholding reviewRefund planningQuarterly tax planningSelf-employed income planningRetirement contribution guidanceTax-efficient money habits
Challenges & Concerns
What financial challenges are you facing right now?
Session Preparation

Please list any topics or questions you want covered during your session:
Please list any financial documents you plan to bring or submit:

Budget / expense listPay stubs / income recordsDebt balancesCredit reportTax return(s)Business income / expense records
Client Acknowledgement
I understand that financial guidance services are educational and strategy-based in nature and do not constitute legal, investment, or licensed financial advisory services.
I acknowledge and agree.
Date

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Date
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Financial Guidance Intake Form

Client Information

Service(s) Requested

Primary Goals

Current Financial Snapshot

Credit & Homebuying Readiness

Tax-Smart Financial Guidance

Challenges & Concerns

Session Preparation

Client Acknowledgement