Welcome & Purpose
Welcome — we’re glad you’re here.This form helps us understand your financial picture so we can give thoughtful, personalized advice.Please complete what you can — estimates are perfectly fine. Anything you’re unsure about, we’ll review together.Your information is confidential and used only for planning and onboarding purposes within Evergreen Wealth Management. No fields are required.
Client Name:
Spouse/Partner (if applicable):
Date of Birth:
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Month
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Day
Year
Date
Date of Birth:
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Month
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Day
Year
Date
Email:
example@example.com
Email:
example@example.com
Phone:
Please enter a valid phone number.
Phone:
Please enter a valid phone number.
Marital Status
Single
Married
Divorced
Widowed
Separated
Other
Citizenship
Please Select
US
Dual-Citizenship
Divorced or widowed? There are social security benefits available to widows and divorced individuals that were previously married over 10 years.
Dependents (names and DOBs) Provide any additional context if needed (special needs or dependent longer term):
Parents and family | Are you caring for your parents health care or foresee this on the horizon? Are there other family members/siblings that we should have involved in your finances now, or into the future?
Are there any financial missteps you've made in the past that has shaped how you view your finances?
What do you feel like you need most help with now or into the future? Are there weak spots you need help with? | Investments, tax, financial planning strategy, etc.
If you have worked with a financial advisor before, in what areas did you feel they came up short in meeting your needs? If you have been managing your own investments, tell me the areas where you're looking for help.
What would success look like for you 5 years from now?
Financial Planning Priorities (check all that apply)
Retirement Planning
Investment Management
Tax Planning
Estate Planning
Education Funding
Insurance Review
Other
Client: Employment Status
Employed Full-Time
Employed Part-Time
Self-Employed
Unemployed
Retired
Student
Client: Employer/Job and income:
Spouse/Partner: Employment Status
Employed Full-Time
Employed Part-Time
Self-Employed
Unemployed
Retired
Student
Spouse/Partner: Employer/Job and income:
Other income sources | Rents, royalties:
Other income, stock options, etc:
Health Insurance Profile | Please tell me about your health insurance situation currently and plans for retirement. Are you and spouse on one employer plan? Does your employer offer any retirement health care options? Are there specifics of Medicare you'll need help navigating?:
Risk Profile Options - Separate Risk Profile Questionnaire to follow
Conservative
Moderate
Aggressive
Other
Planned large expenses (next 2-3 years) | Renovations, travel, weddings, etc:
CPA / Preparer Name or self/Turbotax:
Would you like me to work directly with CPA sending 1099 and tax documents to them?
Have you done any estate planning, establishing trusts, wills, etc?
Retirement
Client: What age would you like to retire? Are you considering working part-time, consulting, or generating income in retirement from work?
Spouse: What age would you like to retire? Are you considering working part-time, consulting, or generating income in retirement from work?
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Income, Savings, and Cash Flow Summary
Income
Rows
Amounts $ | Provide context if needed
Client income - W2 (pre-tax)
Spouse income - W2 (pre-tax)
Social Security (estimate at age 67)
Social Security (estimate at age 67)
Pension/Annuity Income
Rental Income (Net cash flow)
Royalties Income
Inheritances or family gifts
Other (please specify type)
Maxing out 401k? (Yes, or provide amount contributing)
Amount saved annually outside of retirement accounts
This could be automated savings transfers or cash that builds up in checking accounts
Monthly or annual expenses (separate from mortgage payments):
Do you give to charities currently or plan to in the future? Approximately how much?
Asset and Liabilities
Assets and Investments
Rows
Balances | Provide context if needed as well
IRA
IRA
401k/403b/457 plan
401k/403b/457 plan
Roth IRA
Roth IRA
Non-Retirement Brokerage
Checking/Savings (Interest rate on savings?)
Primary Residence value
HSA
Other (please specify type)
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Are there any expected inheritances you expect in the future? Please list any other assets that don't fit in the categories above:
Liabilities
Rows
Balances | Provide context if needed as well
Mortgage - Please provide interest rate, fixed/variable, approximate years to payoff
Other mortgage
Other mortgage
Car loan
Car loan
Other | Please describe
How often would you like to meet in person each year?
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0 (Non-local client)
How often would you like to meet virtually each year?
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