SS-SBA-FC - Financial Checkup | TheMillionaireInsider.com

Step 1 of 4

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Current Personal Status

Single

Married

Significant Other

Widowed

Divorced

Do you have kids, grandkids, or pets?*

Kids

Grandkids

Pets

All of the Above

How did you find out about us?

How do you spend your free time?

Describe Your Current Financial Plan (if you do not have one, then just type "no plan"). If you do, does it include inner game (mindset) and outer game (action) you will take to achieve your goal?

Describe your dream life. If money were not an issue, what would you be doing?

If something else is getting in your way, please explain:

Approximately how much debt do you currently have as a percentage to your net worth (total assets/debt)?*

I have no debt

10%

25%

More than 50%

Unsure

What is your approximate net worth (total assets less liabilities)?*

Less than $100,000

$100,001 to $500,000

$500,001 to $1 Million

$1 Million to $5 Million

$5 Million to $10 Million

More than $10,000,000

What is net worth goal (How much money to you ultimately want to have?)?*

Money doesn't matter to me

I don't believe I can achieve my goal

$100,001 to $500,000

$500,001 to $1 Million

$1 to $5 Million

$5 to $10 Million

$10 Million or more

Do you believe you will inherit money from a partner, parents, or someone else?*

Yes

How much will you inherit?

What are your goals?*

Stop worrying about money

Make sure finances are in order

Create a financial plan

Retire

Fund education for children or grandchildren

Make more money

Grow my business

Have more fun

What is getting in your way (check all that apply)?*

I do not know what to do

I need help creating a plan

Lack of vision

Challenge focusing

Lack of strategy

Money blocks

Mindset, beliefs, and lack of confidence

If you are not retired, how many years until you want to retire?

Are you coachable (meaning are you willing to do the work required to achieve your goal)?*

Yes

What’s your timeline for creating a plan and taking action so you can get your desired results?*

As soon as possible

In 2-3 months

In 3-6 months

The cost (I can't afford to create a plan.)

If you are waiting to complete your plan, please explain what is causing the delay:

How much money do you make each month?*

I am struggling to make ends meet

$100 - $1000

$1001 - $5,000

$5,001 - $10,000

$10,000-$49,999

$50,000 or more

How much money do you want to make each month?*

More, but I have no idea of an amount

$500 - $1,000

$1001 - $5,000

$5,001 - $10,000

$10,000-$49,999

$50,000 or more

How much extra money do you have each month?*

I am struggling to make ends meet

$100 - $1000

$1001 - $5,000

$5001 - $10,000

More than $10,000

Which resources are you most interested in (choose all that apply)?*

Success Mindset

Money or Wealth Blocks

Financial Planning

Retirement Planning

Wealth Strategies

Income Options

Spending and Budgeting

How to Become a Fulfilled Millionaire

What social media platforms do you prefer?*

Instagram

Facebook

TikTok

Twitter

Is there anything else we should know about you?

Thank you for completing The Next Step Assessment. We will receive an email regarding your next step.

Personal Information

Name

First Last

Telephone

Email Address