Confidential Client Questionnaire
An estimate is better than a blank. Where something does not apply, write “N/A.”
Your answers save as you go. When you finish, you will save the form as a PDF and upload it to your eMoney Advisor portal.
THE MORE COMPLETE THIS IS, THE BETTER THE ADVICE BUILT ON IT.
What Brings You In
What made you decide to meet with us?
What would need to be true a year from now for you to say this was worth doing?
What Matters Most
Rate how much each of these matters to you right now.
1 = not a priority · 5 = one of the most important things we could work on
Putting Numbers On It
For your top priority — how much, and by when?
For example: “$6,000 a month starting at 66” or “college covered for both kids by 2034”
What worries you most about your financial situation right now?
About You
Is either of you remarried, or do either of you have children from a prior relationship?
Are there court-ordered support or alimony obligations?
Children & Dependents
If you have none, write “none” on the first line and move on.
| Name | Date of Birth | Birthplace | Social Security Number | Relationship | Lives at Home? | Still Supported by You? |
|---|---|---|---|---|---|---|
Do you help support a parent or another family member?
Contact
Income & Cash Flow
Give yearly amounts, before tax. An estimate is fine.
| Item | You | Spouse |
|---|---|---|
| Employer / Company | ||
| Occupation | ||
| Work Email | ||
| Years With Employer | ||
| Salary | ||
| Bonus | ||
| Commissions | ||
| Self-Employment Income | ||
| Rental Income | ||
| Social Security | ||
| Pension | ||
| IRA / 401(k) Withdrawals | ||
| Annuity Income | ||
| Interest & Dividends | ||
| Other Income (describe) | ||
| Total Yearly Income |
Do you expect your income to change a lot in the next two years?
Do you own a business?
Do you expect an inheritance, business sale, settlement, or other windfall?
What You Own — Cash & Savings
Include everything, not just what you might move to us. Where a line does not apply, write “N/A.”
| Item | Where Held | Rate % | Joint $ | You $ | Spouse $ | Available to move? (Y/N) |
|---|---|---|---|---|---|---|
| Checking | ||||||
| Savings | ||||||
| Money Market | ||||||
| Certificate of Deposit | ||||||
| Health Savings Account (HSA) | ||||||
| 529 / Education Savings | ||||||
| UTMA / UGMA | ||||||
| Other |
Retirement Accounts
| Item | Where Held | You $ | Spouse $ | Available to move? (Y/N) |
|---|---|---|---|---|
| Traditional IRA | ||||
| Roth IRA | ||||
| Inherited IRA | ||||
| SEP / SIMPLE IRA | ||||
| 401(k) / 403(b) / TSP | ||||
| Roth 401(k) | ||||
| 457(b) | ||||
| Pension — Vested Value | ||||
| Deferred Compensation | ||||
| Other |
Do you have a retirement plan still sitting at a former employer?
Investments
| Item | Where Held | Return % | Joint $ | You $ | Spouse $ | Available to move? (Y/N) |
|---|---|---|---|---|---|---|
| Brokerage / Managed Account | ||||||
| Stocks | ||||||
| Mutual Funds / ETFs | ||||||
| Bonds / Bond Funds | ||||||
| Annuity — Note the Type | ||||||
| Employer Stock / RSUs / Options | ||||||
| Business Interest | ||||||
| Other |
Real Estate
| Property | Own or Rent | Market Value $ | Purchase Price $ | Year Acquired | Titled As |
|---|---|---|---|---|---|
| Residence | |||||
| Second Home | |||||
| Rental Property | |||||
| Land | |||||
| Other |
What You Owe
| Debt | Monthly Payment $ | Interest Rate % | Months Left | Unpaid Balance $ | Pay Off at Death? (Y/N) |
|---|---|---|---|---|---|
| Home / Mortgage | |||||
| Second Mortgage / HELOC | |||||
| Automobile | |||||
| Automobile 2 | |||||
| Student / Education | |||||
| Credit Cards | |||||
| Credit Cards 2 | |||||
| 401(k) Loan | |||||
| Medical Debt | |||||
| Taxes Owed / IRS Plan | |||||
| Other |
Insurance In Force
| Type | Carrier | Whose Life | Owner | Beneficiary | Death Benefit $ | Cash Value $ | Loan Against It $ | Premium $ | Term Ends |
|---|---|---|---|---|---|---|---|---|---|
| Life — Term | |||||||||
| Life — Term 2 | |||||||||
| Life — Permanent | |||||||||
| Life — Group | |||||||||
| Disability | |||||||||
| Long-Term Care | |||||||||
| Health | |||||||||
| Property & Casualty |
Have you ever been declined, postponed, or rated (charged extra) for life, disability, or long-term care insurance?
Any health conditions or medications we should know about?
This affects what protection is available and what it costs.
Retirement & Employer Benefits
| Item | You | Spouse |
|---|---|---|
| Planned Social Security Start Age | ||
| Estimated Monthly Benefit at Full Retirement Age | ||
| Employer Retirement Plan | ||
| Contributing? (% or $) | ||
| Employer Match | ||
| Pension — Monthly Benefit | ||
| Pension Survivor Option Elected | ||
| Other Benefits (HSA, FSA, ESPP, RSUs) |
Estate Documents
| Document | In Place? (Y/N) | Date Last Reviewed | Drafted in Which State | Attorney |
|---|---|---|---|---|
| Will | ||||
| Revocable Trust | ||||
| Irrevocable Trust | ||||
| Durable Power of Attorney | ||||
| Health Care Directive | ||||
| Beneficiary Designations Reviewed |
Has anything changed since these were signed — marriage, divorce, a death, a move, or a new child?
Your Other Advisors
| Role | Name | Firm | Phone | May We Contact? (Y/N) | |
|---|---|---|---|---|---|
| CPA / Tax Preparer | |||||
| Attorney | |||||
| Current Financial Advisor | |||||
| Insurance Agent | |||||
| Banker |
How You Think About Risk
How would you feel if your investments dropped 20–30% in a year?
Have you ever lived through a significant investment loss?
Will you need to draw on your investments within the next three years?
Giving & Education
Education funding — which children, how much you intend to cover, and what is saved so far
Closing Questions
Do you feel you are adequately prepared for retirement?
How would you like your estate to pass?
Who should receive what, and is there anything you particularly want to avoid?
Is there a family member who will need special financial provision — now or later?
Are your CPA, attorney, or another advisor key decision-makers for you?
Anything Else
Health, family situation, a change you see coming, or a question you want answered.
Send It To Us
That is everything — thank you. Two steps to send it to us:
- Save it as a PDF. Click Save as PDF below. In the window that opens, set the printer to Save as PDF and click Save. On a phone, tap Share, then Save to Files.
- Upload it to your eMoney Advisor portal. Log in, click Vault at the top of the screen, open the Shared Documents folder, and click the blue Upload Files button.
Please do not email the PDF — it holds personal information. The portal is free and is where we exchange documents safely. No login yet, or your link expired? Click Email us and we will send you a new one.
Once the PDF is uploaded, you can clear your answers from this computer.