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Help Us, Help You!
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What is your name?
(Required.)
What is your preferred method of contact? Please select one.
Phone Call
Email
Text Message
Would you be interested in meeting with your financial advisor via video/Zoom?
Yes, preferred choice
Occassionally
Face-to-face is best for me
Good ol' fashioned phone call
Are you on social media? If so, please check all that apply and provide your info so we can connect!
Facebook
Instagram
LinkedIn
I'm not on social media
My social media info
Would you attend one of our educational webinars?
Yes, I love to learn!
No, I already know everything
I'm not tech savvy
Would you be interested in networking with other Empress clients at events we host? If so, for what purpose? Please select all that apply.
To make friends
To tell them about my business
To expand my network
Other (please specify)
With respect to your investments/retirement, what are you most concerned about today? Check all that apply.
Market volatility/risk
Accumulating wealth
Replacing income
Tax liability
Fees
Strategies for long-term care
Creating a comprehensive plan
Legacy planning
Social security planning
Paying off debt
What is your projected retirement date?
Would you like to receive a written retirement income plan?
Yes
No
I've already received one, thanks!
Do you have long-term care coverage?
Yes
No
If not, are you concerned about potential long term care expenses?
Yes
No
If you are over the age of 65, do you currently have a Medicare supplement plan? If so, please list your plan type.
Yes
No
Not over the age of 65
Plan type:
Have you completed and funded your living trust?
Yes
No
Unsure
In the process
Procrastinating
Do you currently have life insurance coverage? If so, what type of policy do you have? Please check all that apply.
I don't have life insurance
Term insurance
Permanent insurance
Hybrid policy with long-term care
Insured through employer (term)
Not sure what type I have
Do you hold any investment accounts outside of Empress Investment Group? If yes, please select those that apply:
Current employer retirement plan
Previous employer retirement plan
Brokerage account
Mutual funds
Annuity
CDs (Certificate of Deposit)
IRAs (Traditional, Roth, SEP)
Inherited accounts
Not a chance!
Do you currently contribute to an employer-sponsored plan? (401k, 403b, 401a, 457, defined contribution plan, etc.)
Yes
No
If so, have you re-balanced your employer-sponsored plan in the last 6 months?
Yes
No
Not sure
Do you have children? If so, are you interested in Empress Investment Group discussing legacy planning/inheritance/taxation with your beneficiaries?
Do you have grandchildren?
Yes
No
How satisfied are you with our service?
Extremely satisfied
Somewhat satisfied
Satisfied
Needs improvement
Not satisfied
Is there anything we can do to improve your client experience? Don't be shy, your feedback is appreciated!
Would you feel comfortable referring us to a friend or family member? If not, please provide feedback so we can improve:
Would you highly recommend your tax advisor? If so, could you share their information with us please:
Name
Email Address
Phone Number
Would you highly recommend your attorney? If so, could you share their information with us please:
Name
Email Address
Phone Number
