Your Financial Blueprint

Section 1 of 11

About You

The basics — contact info, household structure, and who's in the picture financially.

First name

Last name

Date of birth

State of residence

Email address

Cell phone

What is your current marital status?

Who makes the financial decisions in your household?

This helps make sure the right people are part of the conversation — no surprises later.

I make all financial decisions on my own My spouse or partner and I decide together — both need to be aligned I lead on finances but like to get my partner's input before committing My spouse or partner handles most of it — I'll need to loop them in It's complicated — I'll explain on the call

What is your employment situation?

W-2 employee — I work for someone else Self-employed or sole proprietor Business owner with employees W-2 job plus something on the side Retired or financially independent Currently between jobs or in transition Something else

Industry you work in

Household structure

Single, no dependents Single with dependents (children or family I support) Partnered or married, no dependents Partnered or married with dependents

Do you have children?

Yes No

Do you have grandchildren?

Yes No

If you have children or dependents, what are their ages?

This matters for education planning, insurance needs, and legacy conversations.

Do you own or rent your home?

I own my home (with a mortgage) I own my home outright (no mortgage) I rent I live with family or another arrangement

Do you own any other real estate?

Yes — rental property or investment real estate Yes — second home or vacation property No additional property

Section 2 of 11

Family, Vision & Values

Before we talk numbers — let's understand what you're actually building toward.

Tell me about your family and the people who depend on you — financially, emotionally, or practically.

When you think about money, what are you ultimately trying to create for your family?

What does a rich life look like to you — beyond income or net worth?

Think: time freedom, peace of mind, travel, flexibility, relationships, impact.

What financial lessons did you learn growing up — and what would you like to pass down differently?

If something happened to you tomorrow, what would you want your money, insurance, and planning to accomplish for the people you love?

What are your hopes and dreams for your children or future generations?

What motivates you to keep building and improving your financial future?

What kind of role do you hope to play in your family's life 10, 20, or 30 years from now?

Section 3 of 11

Income & Cash Flow

Income isn't just how much you make — it's how stable it is, where it comes from, and what it looks like after taxes.

Primary annual income (before taxes)

Under $40,000 $40,000 – $75,000 $75,000 – $120,000 $120,000 – $200,000 $200,000 – $350,000 Over $350,000 Discuss on call

Other income — combined annual total

Additional notes on income

How consistent is your income month to month?

Very consistent — I know almost exactly what I'll earn each month Mostly consistent — some variation but generally predictable Inconsistent — varies a lot by month or season Highly variable — I genuinely can't predict it month to month

How much do you currently contribute to registered retirement accounts monthly or annually?

401k, IRA, Roth, SEP, etc.

How much do you currently save or invest outside of retirement accounts?

Brokerage accounts, savings, crypto, real estate — non-registered assets.

How do you file your taxes?

Single Married filing jointly Married filing separately Head of household Self-employed / Schedule C Business entity — S-Corp, LLC, etc. Someone else handles this — I'm not sure

Do you work with a CPA, tax advisor, or bookkeeper?

Yes — I work with a CPA or tax professional regularly Sometimes — for major decisions but not ongoing No — I handle my own taxes (TurboTax, etc.) No — and I know I probably should

Do you expect your income to change significantly in the next 1–3 years?

Yes — I expect it to increase significantly Yes — I expect it to decrease (by choice or circumstance) Somewhat — some changes likely but nothing dramatic No — I expect it to stay about the same I'm not sure

Section 4 of 11

Cash Flow & Money Habits

How money moves through your life — and where it tends to disappear.

Approximate monthly household take-home (after taxes)

Approximate monthly spend

Where does your money flow first when income comes in?

Checking account? Bills? Debt payments? Savings? Business? Lifestyle? Be honest — this is one of the most revealing questions on this form.

Do you feel in control of your money — or does it feel like it's already spoken for before it arrives?

At the end of a typical month, what happens?

I consistently have surplus — money goes somewhere intentional I usually break even — it all gets spent I often come up short or carry balances forward I rely on credit to bridge the gap some months It varies a lot

How clear are you on your monthly cash flow — what comes in, what goes out, and what's left?

Very clear — I know the numbers well Somewhat clear — I have a general idea Not very clear — it's a bit of a mystery honestly

Do you currently follow a budget, cash flow tracker, or spending system?

Yes — I track it closely and know where every dollar goes Loosely — general idea but I don't track closely Not really — I manage by feel or habit No — and I know that needs to change

What percentage of your income do you feel you could consistently redirect — without creating stress at home?

What financial habit — if you mastered it over the next 12 months — would change your life the most?

What major purchases, debts, investments, or opportunities do you expect to finance in the next 3–10 years?

Vehicles, tuition, business expansion, real estate, equipment, travel — anything on the horizon.

Section 5 of 11

Assets & Net Worth

What you own. Include both yours and your spouse or partner's assets.

Roughly how much do you have in liquid savings right now?

Liquid = money you could access in a few days without penalty. Checking, savings, money market — not retirement accounts.

Less than $1,000 $1,000 – $5,000 $5,000 – $15,000 $15,000 – $50,000 Over $50,000 I'd rather discuss this on the call

Do you have a dedicated emergency fund — separate from your spending money?

Yes — 3–6+ months of expenses set aside Partially — some set aside but not fully funded No — my savings and spending are mixed together No emergency fund at all

If you have retirement accounts, roughly what's in them total?

Under $25,000 $25,000 – $100,000 $100,000 – $300,000 $300,000 – $750,000 Over $750,000 N/A — no retirement accounts yet I'd rather discuss on the call

Section 6 of 11

Liabilities & Debt

What you owe. Include monthly payment amounts where possible.

Please include your best rounded estimate for each liability. If you pay weekly or bi-weekly, multiply by 52 or 26 and divide by 12 to get your monthly equivalent.

Total debt load — not counting your primary mortgage

Under $5,000 $5,000 – $20,000 $20,000 – $50,000 $50,000 – $100,000 Over $100,000 I'd rather discuss on the call

Which debts feel like they're slowing your financial progress the most?

How would you describe your relationship with debt right now?

Not the number — how it feels and how it affects your decisions.

When you use money today, what do you think about most?

The monthly payment The interest rate The opportunity cost Long-term control of the capital Just getting what I need right now I haven't thought about it this way

Section 7 of 11

Goals & Priorities

The most important section. Don't give the "right" answer — give the honest one.

What is the single most important financial outcome you want in the next 12 months?

Not "save more" — something real and tangible. "Pay off my car." "Stop carrying a credit card balance." "Put $500/month somewhere it grows."

Six months from now — what needs to have happened for you to feel happy with your progress?

If we were meeting three years from today and looking back — what has to have happened, personally and professionally, for you to feel happy about your progress?

What is the biggest thing standing between you and financial progress right now?

Be real. Income? Debt? Habits? Knowledge? Fear? Time? There's no wrong answer.

What would it mean to you to have a pool of capital that is protected, liquid, and growing — that you could use for life's major expenses?

There's no right answer. Just think about what that would actually change for you.

Section 8 of 11

Protection & Insurance

A plan without protection is just hope. This section makes sure your financial life can survive the unexpected.

Are you currently insured for your full human life value?

Your human life value is the total income you'd generate over your working lifetime. Most people are dramatically underinsured.

Yes — I believe I'm adequately covered No — I know I'm underinsured I don't know — no one has ever calculated this for me

Do you have life insurance on any of your children (a standalone policy, not a rider)?

Yes No N/A — no children

If you understand your current coverage — do you have questions or concerns about it?

What matters most to you when it comes to protecting your family financially? (Select all that apply)

Income replacement Debt payoff Education funding Business continuity Retirement support Legacy / inheritance

If you couldn't work for 3–6 months, how long could you cover your expenses without your income?

Have you thought about long-term care — who pays if you need assisted living, in-home care, or a nursing facility later in life?

Average LTC costs exceed $90,000/year in the U.S. Medicare covers very little. Most people have no plan until they desperately need one.

Yes — I have a long-term care or hybrid policy I've thought about it but haven't done anything yet I plan to self-fund it out of savings I expect family to handle it I hadn't thought about it until now

How do you feel about risk when it comes to your money?

Very conservative — I want safety and guarantees over growth Moderately conservative — some growth is fine with protection Moderate — comfortable with some ups and downs for better returns Growth-oriented — strong returns, can handle market swings Aggressive — maximum growth, I fully accept the risk

Have you ever experienced a significant financial loss — market downturn, bad investment, or major unexpected expense?

Yes — and it significantly changed how I think about money Yes — but I recovered and didn't change my approach much Not really — no significant loss

What frustrates you most about traditional banking or the way you currently access capital?

Section 9 of 11

Health & Lifestyle

This helps determine the best insurance carriers and options available to you based on your unique circumstances.

Height

Weight

Do you currently use tobacco or nicotine products, or have you in the last 12 months?

Cigarettes, cigars, cigarillos, chewing tobacco, nicotine gum, patches, etc.

Yes No

Do you currently vape?

Yes No

Do you use any marijuana-based products?

Smoking, edibles, oils, etc.

Yes No

Do you currently take any prescription medications?

Yes No

Are you currently waiting on medical exams, tests, or procedures that haven't happened yet?

Yes No

Are you waiting on results from medical issues or tests that have been completed?

Yes No

Is there any reason you're aware of that you — or a member of your immediate family — might be uninsurable today?

For example: has anyone already applied for life insurance and been denied?

Yes — there may be an issue No — not that I'm aware of I'm not sure

Section 10 of 11

Business, Estate & Legal

Skip this section if it doesn't apply. If it does — this is where some of the most valuable planning happens.

If you don't own a business and don't have estate planning needs yet, feel free to skip to Section 11.

Do you own a business or work for yourself?

Yes — it's my primary income source Yes — it's a side business or secondary income No — I work for someone else

Is there anyone else needed or involved when you make major financial decisions for your business?

Yes No N/A

Do you have a succession or exit plan for your business?

Yes — documented plan in place Loosely — some ideas, nothing formal No — I know I need to address this No — haven't thought about it N/A

Do you have a buy-sell agreement or key person insurance?

If you have a business partner, these protect the business if one of you dies, becomes disabled, or wants out.

Yes — both in place Partially — one or the other No — not set up N/A — solo operator or no business

Are your personal and business finances kept separate?

Yes — completely separate accounts and bookkeeping Mostly — some overlap Not really — it all flows together N/A

Do you have a will or a trust?

Yes — will and/or trust in place Partially — some documents but outdated or incomplete No — I know I should but haven't done it No — and honestly I haven't thought much about it

Do you have a family trust set up?

Yes No

Do you have beneficiaries named on your financial accounts, insurance, and retirement accounts?

A named beneficiary overrides a will. If it's out of date, the wrong person could inherit your money — regardless of your wishes.

Yes — current and correct Yes — but I haven't reviewed them in years I'm not sure if I have them set up No — haven't done this

Section 11 of 11

Knowledge, Mindset & Final Thoughts

The last stretch. This helps me meet you where you are and understand what's really driving this conversation.

How would you rate your overall financial literacy?

1 = just getting started — 5 = very confident and knowledgeable

Just getting startedVery knowledgeable

How would you rate your level of knowledge around investing and growing your assets?

1 = very little knowledge or confidence — 10 = actively manage your own investments and educate yourself regularly

Little to no confidenceActively self-managing

Have you ever worked with a financial professional before?

Yes — and it was helpful; I want to go deeper Yes — but it didn't stick or go anywhere I've tried on my own but never with a professional No — this is the first time I'm thinking about this seriously

Is there anything you've tried financially that left a bad taste — bad advice, the wrong product, a plan that fell apart?

Knowing this means we won't repeat it. It also tells me a lot about what you actually need.

How committed are you to learning and implementing something new in your financial life right now?

1 = just curious, not ready to act — 5 = ready to move immediately

Just exploringReady to move

How urgent does your financial situation feel to you right now?

1 = no rush, just planning ahead — 5 = I need to make moves now

Planning aheadNeed to move now

What made this the moment you decided to do something?

Something usually triggers this. A conversation, a number that scared you, a life event, something you read or watched. The trigger tells me what's really driving this.

What is the one thing you most want me to understand about your financial situation before we talk?

What would make this conversation a success for you?

What would you need to walk away feeling so that this was worth your time?

How did you hear about me?

Referral from a friend, colleague, or client LinkedIn Instagram, Facebook, YouTube, or social media Content I came across (post, video, article, podcast) A specific event or community Online search Other

Is there anything else this form didn't ask that you think I should know?

Your Financial
Blueprint

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Your FinancialBlueprint

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Your Financial
Blueprint