Financial Intake Form
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First Name
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Last Name
*
Primary Email
*
Is your income primarily W2, self-employed, or a blend of both?
What’s your average monthly take-home after taxes?
If self-employed—does that stay consistent or fluctuate?
Make a selection
Consistent
Fluctuate
Do you receive bonuses or commissions?
Make a selection
Yes, Bonuses
Yes, Commissions
Yes, Both
Neither
Has your income been growing, holding steady, or declining over the past few years?
Make a selection
Growing
Holding Steady
Declining
Do you have any of the following accounts?
401(k)
Roth
IRA
Brokerage Accounts
CDs
HSA
Other
Are these being actively managed or mostly left alone?
How involved do you feel in those decisions?
Do you understand how your assets are allocated across tax categories?
What does your current debt picture look like—mortgage, credit cards, auto, student loans, or others?
Mortgage(s)
Credit Card(s)
Auto Loan(s)
Student Loan(s)
Other
Are you working off any structured payoff plan, or just managing it monthly? Please detail the plan below.
Are there debts you’re looking to eliminate within the next 12–24 months?
How much is your core fixed living expenses (i.e. housing, food, insurance, utilities, transportation)?
Any irregular or large seasonal expenses? (tuition, travel, healthcare, etc.)
Do you have a monthly budget you stick to—or more of a general range?
Do you have other significant assets like real estate, businesses, crypto, or family trusts? Please detail below.
Would you want those included in your plan—or are they more separate?
Make a selection
Included
Separate
Are any of these assets income-generating?
Make a selection
Yes
No
Submit
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