If different from client, or if client needs assistance with decision-making
Are you legally authorized to make decisions for the client? *? If yes, please specify (e.g., Power of Attorney, Guardianship):
What prompted you to seek referrals for professional services at this time? * ? (e.g., recent life event, desire for comprehensive planning, family discussion)
What are your primary goals for this consultation? * ? (Please check all that apply and elaborate below)
Do you currently have a Will? * ? If yes, when was it last reviewed/updated?
Do you have a Durable Power of Attorney for Finances? * ? If yes, who is appointed?
Do you have an Advance Directive for Healthcare? * ? (Living Will/Healthcare Power of Attorney)? (Yes/No) If yes, who is appointed?
Are you currently working with a Financial Advisor? *? If yes, name/firm:
What are your primary sources of income? * ? (e.g., Social Security, pension, investments, part-time work)
Do you have a clear understanding of your current assets and liabilities? * ? (e.g., bank accounts, investments, real estate, debts)
What are your retirement goals? *? (e.g., travel, staying in home, specific lifestyle)
Do you currently have any life insurance policies? *? If yes, please list provider(s) and policy type(s) if known:
What is the primary purpose of your current or desired life insurance coverage? * ? (e.g., cover final expenses, leave an inheritance, provide for a spouse/dependent, charitable giving)
Do you understand the different types of life insurance and which might be suitable for you? * ? (e.g., Term, Whole Life, Universal Life)
Relevant for life insurance underwriting and long-term care planning
List any current medications * ? (including over-the-counter and supplements)
Have you had any recent hospitalizations or major medical events? *? If yes, please describe:
Do you have any preferences regarding the location of the professional's office? * ? (e.g., local, virtual)
Are there any specific qualifications or characteristics you are looking for in a professional? * ? (e.g., fee-only advisor, specific designations)
Veteran Status *? If yes, please list branch and dates of service:
