Name

Email

Company

Address

City/State/Zip

Phone Number

1. Do you have a clear vision for the future?

1-10

2. Do you have clear life and financial goals?

1-10

3. Do you have a step-by-step action plan to achieve the set goals?

1-10

4. Are your investments scattered, disorganized and poorly mixed?

1-10

5. Have you reviewed all of the tools which could help you achieve the vision?

1-10

6. Do you have a plan to guard against losses from LTC, disability or premature death?

1-10

7. Do you have a transition plan in place for the estate?

1-10

8. Do you review the vision, plan or progress on a regular basis?

1-10

9. Do you believe financial advisors should work as a team?

1-10

10. Do you have a strong sense about the future?

1-10

Total