Financial Fitness Survey (Pre-Retirement)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Your responses to the following statements will help you to identify the areas where you could benefit from when working with a financial planner. Please indicate your response to each statement where:
1 = Unsure or do not know 2 = No (not true) 3= Sometimes 4= Yes (that’s me)
Leave blank if not applicable.

Name *

Survey Type: *

Pre-Retirement

Retirement

1. Quality of life – I feel comfortable…

with where I currently live

Unsure/No

Yes

Clear selection

with the level and regularity of my savings

Unsure/No

Yes

Clear selection

with my financial situation and it does not worry me

Unsure/No

Yes

Clear selection

that my financial situation does not worry my spouse/partner

Unsure/No

Yes

Clear selection

with my spending habits

Unsure/No

Yes

Clear selection

with my partner/spouse/dependents spending habits

Unsure/No

Yes

Clear selection

that I pay off credit cards each month

Unsure/No

Yes

Clear selection

that I will be able to acquire the new ( fill in the blank ) that I desire

2. Retirement – I have…

determined how much I need to save for a comfortable retirement

Unsure/No

Yes

Clear selection

determined when I can afford to retire

Unsure/No

Yes

Clear selection

defined goals for my retirement years

Unsure/No

Yes

Clear selection

prioritized those retirement goals

Unsure/No

Yes

Clear selection

3. Other life events – I currently have a plan as to how to…

purchase my next car without borrowing

Unsure/No

Yes

Clear selection

fund my children’s education

Unsure/No

Yes

Clear selection

fund my grandchildren’s education

Unsure/No

Yes

Clear selection

help my family in ways I desire

Unsure/No

Yes

Clear selection

fund my children’s wedding(s)

Unsure/No

Yes

Clear selection

4. Investments – I am confident…

my investments adequately reflect my risk tolerance/capacity

Unsure/No

Yes

Clear selection

my investments are properly diversified

Unsure/No

Yes

Clear selection

that I have a “plan” for my investments (Investment Policy Statement)

Unsure/No

Yes

Clear selection

I know how the costs and fees impact my portfolios performance

Unsure/No

Yes

Clear selection

my portfolio has the highest return for the risk I am willing to take

Unsure/No

Yes

Clear selection

in the investing I have done to date

Unsure/No

Yes

Clear selection

5. Risks - I am certain that I am adequately protected…

if my home were to burn to the ground

Unsure/No

Yes

Clear selection

if I were to be sued for a huge liability

Unsure/No

Yes

Clear selection

if I became unable to work

Unsure/No

Yes

Clear selection

in the event of a health treatment costing $3 million

Unsure/No

Yes

Clear selection

in case of a 4 year long-term care stay when I’m age 80

Unsure/No

Yes

Clear selection

if I died prematurely, my family would be financially taken care of

Unsure/No

Yes

Clear selection

6. Estate Planning – I am certain that my current estate planning documents will…

safeguard my minor children at my death

Unsure/No

Yes

Clear selection

minimize estate tax as much as legally possible

Unsure/No

Yes

Clear selection

not require modification when the Estate Tax laws change

Unsure/No

Yes

Clear selection

make it difficult to have my final wishes disputed by others

Unsure/No

Yes

Clear selection

make transfer of assets to my heirs as effortlessly as possible

Unsure/No

Yes

Clear selection

keep estate administrative costs as low as possible

Unsure/No

Yes

Clear selection

make it easy for me to be cared for if I become incapacitated

Unsure/No

Yes

Clear selection

assure my life support decisions will be followed without a legal battle

Unsure/No

Yes

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Chamberlain Financial Planning. Report Abuse

Forms