To what extent do you agree or disagree with the following statement about your financial picture and mindset?

My financial decisions support the life I want to live and the person I want to be.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I understand the beliefs, emotions, and biases that influence my financial decisions.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I have a clear view of my complete financial picture – all of my assets (what I own) and my liabilities (what I owe)

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

Money is a cause of stress, anxiety, or worry in my life.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I have specific financial goals and clear strategies to achieve them.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I review my financial goals regularly and track my progress towards them.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

What was your Household Income last year?

Less than $40,000
$40,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $249,999
Over $250,000

How much of your after-tax income are you able to save each month?

20%+
16%-20%
11%-15%
6%-10%
0%-5%
I don’t know

I track my cash flow each month and know how much I spend, save, and invest.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I am taking advantage of all available strategies to reduce the taxes I pay.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I review my taxes and proactively plan for upcoming personal, professional, and financial changes.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

My Credit Score is

800+
740-800
670-739
580-669
Below 579
I Don't Know

How much of your monthly income goes toward debt payments? (mortgage, car loan, student loans, etc.)

<10%
11%-20%
21%-30%
31%-40%
>40%
I don’t know

My debt and monthly payments are a cause of stress in my life.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

How much of your after-tax monthly income are you investing?

>15%
11-15%
6-10%
1-5%
0%
I don’t know

I have a clear picture of all investments and the level of risk I am taking.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

How many months of expense could your Emergency Fund cover?

7+ months
5-6 months
3-4 months
1-2 months
0. I don’t have an emergency fund

I have insurance coverage in all of the categories that are important to my financial well-being (e.g. health, disability, life, and property (e.g. home, car).

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I review my insurance policies regularly and after major life changes to ensure they are up to date.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

When were your estate planning documents executed (e.g. your will, financial power of attorney, advanced healthcare directive)?

Within the last 3 years
Between 3-5 years ago
Greater than 5 years ago
N/A / I don’t have any

I review my estate planning documents regularly to ensure they are up to date.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

To what extent is Education Planning a concern of yours?

Not a concern/interest and unlikely to be in the future
Likely to be a concern/interest at some point in the future
Education Planning is a current concern/interest

As a percentage of your income, how much are you saving towards an education?

5%+
4-5%
3-4%
1-2%
I am not currently saving

I am saving enough and using all tax savings opportunities available.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

As a percentage of your income, how much are you saving for retirement?

>21%
16-20%
11-15%
6-10%
<5%, but not zero
0%
I don’t know

How much have you already saved towards retirement?

$0 to $24,999
$25,000 to $99,999
$100,000 to $249,999
$250,000 to $999,999
$1,000,000 and up

I know how much money I need to save in order to achieve a financially secure retirement.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I have the expertise and time to effectively implement all aspects of my financial plan.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

I periodically review my financial plan to evolve my strategies when there are changes in my life.

Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree

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