Financial Checkup: Greater Wellness, Clarity, & Financial Freedom

Step 1 of 4

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Your information is confidential and will never be shared!

Name

First Last

Current Personal Status

Single

Married

Significant Other

Widowed

Divorced

How did you find us?

How confident are you about your retirement plan?

I should be okay in retirement, but not sure.

I don't have enough money to retire.

I am set and have confirmed this with a professional.

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

Describe your dream life. If money weren't an issue, what would you be doing?

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?)?*

$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?*

Retire without worry

Make sure finances are in order

Create a financial plan

Make more money

Grow my business

Fund education for children or grandchildren

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 or strategy

Money blocks

Lack financial confidence and clarity

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

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

$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)?*

Retirement Planning

Estate Planning

Financial Planning

Wealth Strategies

Income Options for Retirement

Spending Plan

What social media platforms do you prefer?*

Instagram

Facebook

Is there anything else we should know about you?

Would you like to talk with us?*

Yes

Telephone (Please provide so we can clarify information or you can talk with us!)

Let us know if there is anything else we should know.

For Greater Wellness, Clarity, and Financial Freedom

Your information is confidential and will never be shared!

Thank you for completing. We will be in touch shortly.