How Can We Help? Survey

Question Title

* 1. Please select any recent life events (check all that apply)

New child or grandchild

Change in marital status

Death or disability of a family member or business partner

Health Concerns

New Job or promotion

Sold or acquired assets/business

Change in Estate Plan

Sale or Purchase of Home

New Investments or Insurance

Retirement

Other (please specify)

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* 2. What are your most important personal or family goals?

	Very Important	Important	Neutral	Not Important
Your family's lifestyle in the event of a death or disability	Your family's lifestyle in the event of a death or disability Very Important	Your family's lifestyle in the event of a death or disability Important	Your family's lifestyle in the event of a death or disability Neutral	Your family's lifestyle in the event of a death or disability Not Important
Funding education for children or grandchildren	Funding education for children or grandchildren Very Important	Funding education for children or grandchildren Important	Funding education for children or grandchildren Neutral	Funding education for children or grandchildren Not Important
Preparing for retirement	Preparing for retirement Very Important	Preparing for retirement Important	Preparing for retirement Neutral	Preparing for retirement Not Important
Providing a legacy for heirs	Providing a legacy for heirs Very Important	Providing a legacy for heirs Important	Providing a legacy for heirs Neutral	Providing a legacy for heirs Not Important
Other	Other Very Important	Other Important	Other Neutral	Other Not Important

If you marked other please specify

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* 3. How can we help you improve your financial situation?

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* 4. What are the top items you would like to discuss or like information on

Create a Financial or Retirement Plan

Set Goals and determine if we are on track

Life, disability and long term care insurance

Investments/ Investment Risk

Answer financial questions

Social Security and Medicare

Other

Question Title

* 5. When you present financial ideas and solutions to me; (please indicate which best describes you)

I would like products and services that best align with my values

I want multiple options and the bullet point version

I am open to change and 'outside the box' thinking

I like as much detail and facts as possible

Other (please specify)

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* 6. When making a decision; (please indicate the option that best describes you)

I need time to process the facts so I can understand every detail

I want to make a decision in the moment because I don't have time to leave loose ends untied.

I need to sleep on decisions but need to have a deadline so I am sure to follow through

I want to have a conversation with my financial team (CPA, Financial Planner, Spouse, Family) and make a decision together

Other (please specify)

Question Title

* 7. Would you like to set up a meeting?

Yes, I would like to set up a time for face to face meeting

Yes, I would like to set up a time to meet over the phone or on zoom

Not right now- but get in touch with me later. (Enter Details in Comments Section Below)

Yes, I already have an appointment set

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* 8. Comments

Question Title

* 9. Contact Information

Name

Email Address

Cell Phone Number

Please bring the following documents to our meeting.
- Investment Account Statements, including retirement and 401(k) statements
- Insurance policy information
- Employee benefits information
- Document relating to debts you may owe, such as loans or mortgages
- Income and cash flow information, such as recent pay stubs and income tax returns

Securities and investment advisory services offered through Osaic Wealth, Inc. (Osaic Wealth) member FINRA/SIPC. Osaic Wealth is separately owned and other entities and/or marketing names, products or services referenced here are independent of Osaic Wealth.