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These questions will give me an idea of your current habits, beliefs, and experience.   Your answers will help us move through our work quicker to get you where you want to be. Please fill this out at least one day prior to our first meeting so I'll have time to look it over.  Thank you 

 

This statement describes me:


I am able to save moneyCompletelyVery wellSomewhatVery littleNot at all{"type":"select","name":"__generic6","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Completely\nVery well\nSomewhat\nVery little\nNot at all"}



I am concerned that the money I have or will save won’t last
CompletelyVery wellSomewhatVery littleNot at all{"type":"select","name":"__generic7","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Completely\nVery well\nSomewhat\nVery little\nNot at all"}



 

How often does this statement apply to you? 

Giving a gift for a birthday or other occasion would put a strain on my finances for the month
AlwaysOftenSometimesRarelyNever{"type":"select","name":"__generic10","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Always\nOften\nSometimes\nRarely\nNever"}



I have money left over at the end of the month
AlwaysOftenSometimesRarelyNever{"type":"select","name":"__generic11","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Always\nOften\nSometimes\nRarely\nNever"}


 

Do you feel like you struggle to get things done?AlwaysOftenSometimesRarelyNever{"type":"select","name":"__generic21","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Always\nOften\nSometimes\nRarely\nNever"}

 

In the last three months, have you?  

Followed a written personal budget, spending plan, or tracked your monthly expenses
{"type":"checkbox","name":"__generic22","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo\nDon't Know"}



Had to choose which bills to pay since you couldn't pay them all.{"type":"checkbox","name":"__generic25","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo\nDon't Know"}



Paid a late fee on a loan or bill or currently owe a late fee{"type":"checkbox","name":"__generic26","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo\nDon't Know"}

 

Current Money Management Style


Do you have a checking or savings account?  
{"type":"checkbox","name":"__generic29","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Checking\nSavings\nNone"}



What do you pay on your credit card each month?
Minimum amountPartial paymentEntire balanceI don't have a credit card{"type":"select","name":"__generic30","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Minimum amount\nPartial payment\nEntire balance\nI don't have a credit card"}



Which statement applies to your spending?
Spend money as soon as I have itSpend some of my incomeHave money in the bank but I feel like I don't have enough money{"type":"select","name":"__generic32","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Spend money as soon as I have it\nSpend some of my income\nHave money in the bank but I feel like I don't have enough money"}



How would you rate your current credit score?

Don’t knowVery badPoorAverageGoodExcellent{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Don’t know\nVery bad\nPoor\nAverage\nGood\nExcellent"}

 

Past Money Experiences


Was money talked about in your family? 
{"type":"checkbox","name":"__generic37","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo"}


If yes, what three words (or more) might describe it?
{"type":"text","name":"__generic38","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}


or you can choose words from this list
{"type":"checkbox","name":"__generic2","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"abundance\ncomfort\nmixed feelings\nmistrust\nshame\nguilt\nfear\nanxiety\nchaos"}



Have you explored tools to help you with your finances such as money blogs, books, seminars, or apps? 
{"type":"checkbox","name":"__generic39","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo"}


Which ones did you find helpful?
{"type":"text","name":"__generic40","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}


 

Goals for the Future


Are you comfortable using online tools for tracking expenses, scheduling payments, and recording your progress? 
{"type":"checkbox","name":"__generic44","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo\nNot Sure"}



Do you currently have one or two financial goals in mind?  If yes, please choose from the following: 

{"type":"checkbox","name":"__generic45","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Starting and maintaining a budget to live within my income \nDecreasing spending\nLearning basic money management \nSaving towards a goal like buying a house, going to college, or retirement\nUnderstanding how credit reports and credit cards work\nBuying a car\nOther"}

 {"type":"text","name":"__generic3","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}

Personal

Have you ever experienced coaching before? 

{"type":"checkbox","name":"__generic46","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo\nNot sure"}

 

What did you like and not like?  If possible, I'd like to customize our work to what would be best for you.

{"type":"text","name":"__generic47","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}

 

Have you ever taken a personality quiz?

{"type":"checkbox","name":"__generic48","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Kolbe Index\nMyers/Briggs\nOther\nNone"}

Are you willing to share results?

{"type":"checkbox","name":"__generic49","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Yes\nNo\nNot sure\nDon't have results, but I'd like to take a quiz\nDon't have one and I am not interested"}

 

Do you have more on your mind concerning your relationship with money and how it relates to your needs, values, and activities?

{"type":"text","name":"__generic4","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}