Menu
Home
About
Our Services
Financial Planning
Wealth Management
Insurance Protection
Group Benefits
Resources
Newsletter
Blog
Worksheets & Questionnaires
Education
Calculate Your Risk Score
Webinars
Client Login
RightCapital
eMoney
Prudential.com (LPL)
SCHEDULE A MEETING
VHFS New Client Questionnaire
First Name
Last Name
Age
Email
Phone
Address
Marital Status
Please Select One
Single
Married
Widowed
Separated
Divorced
Other
Preferred method of contact?
Email
Phone
Best time to contact
Morning
Afternoon
Evening
Occupation
Annual income
Do you (or your spouse) own a business?
Yes
No
Do you have any of the following estate planning instruments? (select all that apply)
Last Will & Testament
Living Will
Power of Attorney
Healthcare Proxy
Irrevocable Trust
Revocable Trust
Special Needs Trust
Charitable Trust
Grantor Retained Annuity Trust
Irrevocable Life Insurance Trust
Spendthrift Trust
Generation Skipping Trust
Other
If other, please specify
Do you have any of the following? (select all that apply)
Life Insurance
Health Insurance
Disability Insurance
Long-Term Care Insurance
Does your spouse have any of the following? (select all that apply)
Life Insurance
Health Insurance
Disability Insurance
Long-Term Care Insurance
Please rank the following in order of priority (1 = highest priority)
Save for major purchase
Select Priority
1
2
3
4
5
6
7
8
Planning for retirement
Select Priority
1
2
3
4
5
6
7
8
Education funding & planning
Select Priority
1
2
3
4
5
6
7
8
Minimize estate taxes
Select Priority
1
2
3
4
5
6
7
8
Tax efficiency through tax planning
Select Priority
1
2
3
4
5
6
7
8
Risk management and asset allocation
Select Priority
1
2
3
4
5
6
7
8
Special needs planning
Select Priority
1
2
3
4
5
6
7
8
Cash Flow and Debt Management strategies
Select Priority
1
2
3
4
5
6
7
8
What topics are you most interested in discussing?
Any other general information we should be aware of?
Submit
Thank you for your submission!
There was a problem with the form submission. Please try again.
