Financial Planning Needs Form

The following questions will help you prioritize your financial planning needs. Please complete the Background Information and answer the questions. Upon submission we will e-mail you a custom summary to show the areas that need attention.
 

Background Information
 
Name
DOB (mm-dd-yyyy)
Address
City
State
Zip Code
Email
Phone
Occupation
Income
Spouse
Children
 

The following questions concern your budget
 
Do you have a budget
 

Risk management
 
Do you have life insurance
Do you have disability insurance
Have you reviewed your Home Owners Insurance in the last 3 years
Do you have an umbrella policy
Do you understand your medical insurance and deductibles?
 

Investments
 
Do you understand the asset allocation of your investment portfolio?
Would you like help in monitoring your asset allocation?
 

Estate
 
Do you have a will?
Are all your beneficiaries up to date
Is ease of administration of your estate important to you?
Are you concerned about charitible giving
Do you heirs understand you estate plan?
 

Retirement
 
Have you started to save for retirement?
Do you know what you should receive from Social Security
Do you understand your health care options?
Do you know what you should receive from Social Security
Do you know what you want to do in retirement?
Did you know that you may live to 100
Have you considered Long Term Care Insurance
Do you have a budget for retirement
 

Taxes
 
Did you get a refund of your taxes this past year?
Do you know your effective tax rate
Do you think you pay too much in taxes
Do you know what estate tax bracket you will be in?
 

Employer benefits
 
Do you understand your employer benefits
Do you understand your 401(k) or 403(b) options
Do you understand the difference in employer provided insurance and personal insurance
Do you feel pressured to buy some of the benefits
 

Job security
 
Are you concerned about losing your job?
Do you expect a major change in your lifestyle in the next 5 years
 

Any other concern that you may have