Financial Fitness Survey (Pre-Retirement)

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

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