Client Questionnaire

US Citizen?
Do you have Life Insurance currently?

Personal History

Currently Disabled?
Tobacco Use over the past 2 years? Or CBD/Hemp Usage?
Have you been convicted for a DWI or DUI in the past 5 years?
Have you ever been convicted for a felony?
Have you been in a car accident where you were found at fault and CITED in the past 3 years?
Do you have any BOOKED foreign travel over the next 2 years?
Are you enlisted or intend on joining the Military?
Are you or do you plan on becoming a licensed pilot?
Do you participate in any extreme sports such as bungee jumping, rock climbing, racing cars, scuba diving, parachuting, or anything "extreme"?
Do you have a primary care physician?

Employer Information

Note: If retired, type N/A under the fields below that do not apply to you.

Finances + Savings

What are your top financial and savings priorities? Check all that apply.
Do you feel confident in your current savings approach?
Do you feel your current savings approach is appropriately diversified when it comes to growing and protecting your assets?
Do you feel your current savings approach is appropriately diversified when it comes to delivering adequate income that can last through retirement?
Do you feel your current savings approach is appropriately diversified when it comes to protecting you from future tax changes?
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Has a financial professional ever calculated your total potential taxes in your current saving strategy?

Thank you! We will be in touch shortly.