Retirement Planning/Financial Assessment Discovery Form
First Name
Last Name
Email
Phone Number
Address
What is your current age?
Select an option
Over 65
61-65
56-60
46-55
36-45
under 35
What is your current financial priority?
Select an option
just getting started
building up my savings
growing my wealth
retaining my wealth
How confident are you in your long-term financial plan?
not confident
somewhat confident
very confident
What activity is most important to you in retirement?
Select an option
traveling
spending time with family and friends
pursuing hobbies
working part-time
Other
What word accurately describes your vision of retirement?
Select an option
Enjoyment
Freedom
Leisure
Other
Where do you expect the majority of your retirement income to come from?
Select an option
Savings and Investments
Employer ( Pensions)
Government
Other
Are you planning on relocating for retirement?
Select an option
yes
no
unsure
How would you characterize your overall health?
Select an option
Poor
somewhat good
excellent
Has your health caused you financial difficulty or stress?
Select an option
yes
no
unsure
How comfortable are you with investing?
Select an option
not comfortable
somewhat comfortable
very comfortable
How quickly would you like to improve your long-term financial strategy?
Select an option
As soon as possible
within the next 3 months
within the next year
no specific time frame/I don't want to make any changes.
Are you married?
Select an option
yes
no
Do you own your home?
Select an option
yes
no
Do you currently have children under 18?
Select an option
no
yes, 1
yes, 2
yes, 3 or more
Do you own a business?
Select an option
yes
no
Are you currently invested in inflation protected assets?
Select an option
yes
no
unsure
Do you have a 401K?
Select an option
yes
no
Do you have an IRA?
Select an option
yes
no
Do you have an emergency fund?
Select an option
yes
no
Which of these is most important for your financial advisor to have?
Select an option
Tax expertise
Investment management expertise
estate planning expertise
none of the above
Is socially responsive investing important to you?
Select an option
not important
must have
Do you currently have a financial advisor?
Select an option
yes
no
Please estimate your household income.
Select an option
Less than $40,000
$40,000 to $74,999
$75,000- $99,999
$100,000- $149,999
$150,000- $249,999
Over $250,000
Please estimate your total investable assets.
Select an option
Less than $25,000
$25,000-$99,000
$100,000-$249,999
$250,000-$999,000
$1,000,000- $4,999,999
Over 5,000,000
Please estimate your current monthly savings.
Select an option
Less than $100
$100-$249
$250-$499
$500-$999
$1000-$1999
Over $2000
Submit
Powered by