Helping individuals and families prioritize their spending in order to reach their financial goals

Thank you for your interest in participating in the financial wellness benefit provided by [EMPLOYER NAME].

Please fill out this quick questionnaire

Name

First Name

Last Name

Phone

(###)

###

####

Overall, how do you feel about your finances?

What are your top 3 financial concerns?

What are your top 3 financial goals (build an emergency fund, pay off debt, buy a car, buy a house, etc.)?

Do you currently have a budget?

Yes

Kind of - I try, but it's a struggle

Do you feel like you are on track to have enough money in retirement?

Do you feel financial stress is affecting your job, health or relationships?

If you were faced with a $1,000 emergency, how would you manage that? (Savings, credit card, borrow from retirement account, unsure)

What is your biggest struggle when it comes to managing your finances?