• Rich Lifestyle Solutions Financial Wellness Intake Form

    Welcome! Thank you for choosing Rich Lifestyle Solutions. This intake form helps us understand your current financial picture so we can create a personalized financial strategy tailored to your goals. Please answer each question as accurately as possible. All information is kept confidential and used solely for financial coaching purposes.

  • Personal Information

  • Format: (000) 000-0000.
  • Date of Birth
     - -

  • Financial Goals

  • What brings you here today?*

  • Household Income

  • Monthly Expenses

  • Assets

  • Debts

  • Please enter each debt as a separate row. Include all current debts, even if paid irregularly or in collections.
  • Include Debts in Collection

  • Credit

  • Have you reviewed your credit report within the last six months?
  • Do you have any collections?

  • Savings & Insurance

  • Spending Habits

  • Do you currently use a budget?*
  • Biggest financial challenges

  • Coaching Expectations

  •
  • How soon would you like to begin implementing your financial plan?*

  • Document Upload

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  • Upload a File
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  • Upload a File
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  • Upload a File
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  • Upload a File
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  • Upload a File
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  • Agreement

  • Date*
     - -
  • Appointment

  • My Products

    prevnext( X )
      60 minute consultation. * Review intake form * Discuss your Financial goals * Identify your biggest financial challenges * Discuss Next steps for your plan of success * Discuss which coaching package fits your needs
      60 minute consultation

      * Review intake form

      * Discuss your Financial goals

      * Identify your biggest financial challenges

      * Discuss Next steps for your plan of success 

      * Discuss which coaching package fits your needs

      $75.00$75.00
        
      90 minute consultation

      * Review intake form

      * Discuss your Financial goals

      * Identify your biggest financial challenges

      * Discuss Next steps for your plan of success 

      * Discuss which coaching package fits your needs

      $150.00$150.00
        
      Total
      $0.00$0.00

      Payment Methods

      creditcard
      After submitting the form, you will be redirected to Apple Pay to complete the payment.
      After submitting the form, you will be redirected to Cash App Pay to complete the payment.
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