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Full Name
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On a scale from 1 to 5 how confident are you in your retirement income plan?
1 - Not Very Confident
2 - Somewhat Not Confident
3 - Somewhat Confident
4 - Very Confident
5 - Extremely Confident
How strongly do you feel prepared to receive the quality of care you would like if you need long-term care?
1 - Very Unprepared
2 - Somewhat Unprepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Well Prepared
How confident are you that if taxes go up that you are prepared to avoid paying higher taxes in retirement?
1 - Very Unprepared
2 - Somewhat Unprepared
3 - Somewhat Prepared
4 - Well Prepared
5 - Very Well Prepared
How confident are you in your current team of financial professionals?
1 - Not Very Confident
2 - Somewhat Not Confident
3 - Somewhat Confident
4 - Very Confident
5 - Extremely Confident
How comfortable are you with your current level of risk with your investments?
1 - Very Uncomfortable
2 - Somewhat Uncomfortable
3 - Somewhat Comfortable
4 - Very Comfortable
5 - Extremely Comfortable
How well do you think your current savings accounts and CDs are capturing the best interest rate possible?
1 - Not Very Well
2 - Somewhat Unwell
3 - Somewhat Well
4 - Well
5 - Very Well
What’s your source of income?
Investment
Business
Employment
Retirement
Unemployed
How much debt do you have? (not including your mortgage)
0 - $5,000
$5,001 -$15,000
$15,001 - $30,000
$30,001 - $50,000
$50,000+
I have no debt.
How much do you currently have in assets such as savings and investments?
Under $10,000
$10,000 - $50,000
$50,000 -$250,000
$250,000 - $1M
$1M
What is your household’s annual income?
What is the one area you would like to see improved immediately?
What is your biggest financial concern at the moment?
Who is your number one financial influence where you obtain most of your current information about retirement?
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