Help Us, Help You! Question Title * What is your name? Question Title * What is your preferred method of contact? Please select one. Phone Call Email Text Message Question Title * 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 Question Title * 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 Question Title * Would you attend one of our educational webinars? Yes, I love to learn! No, I already know everything I'm not tech savvy Question Title * 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) Question Title * 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 Question Title * What is your projected retirement date? Question Title * Would you like to receive a written retirement income plan? Yes No I've already received one, thanks! Question Title * Do you have long-term care coverage? Yes No Question Title * If not, are you concerned about potential long term care expenses? Yes No Question Title * 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: Question Title * Have you completed and funded your living trust? Yes No Unsure In the process Procrastinating Question Title * 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 Question Title * 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! Question Title * Do you currently contribute to an employer-sponsored plan? (401k, 403b, 401a, 457, defined contribution plan, etc.) Yes No Question Title * If so, have you re-balanced your employer-sponsored plan in the last 6 months? Yes No Not sure Question Title * Do you have children? If so, are you interested in Empress Investment Group discussing legacy planning/inheritance/taxation with your beneficiaries? Question Title * Do you have grandchildren? Yes No Question Title * How satisfied are you with our service? Extremely satisfied Somewhat satisfied Satisfied Needs improvement Not satisfied Question Title * Is there anything we can do to improve your client experience? Don't be shy, your feedback is appreciated! Question Title * Would you feel comfortable referring us to a friend or family member? If not, please provide feedback so we can improve: Question Title * Would you highly recommend your tax advisor? If so, could you share their information with us please: Name Email Address Phone Number Question Title * Would you highly recommend your attorney? If so, could you share their information with us please: Name Email Address Phone Number Next
