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.
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Name
*
Your answer
Survey Type:
*
Pre-Retirement
Retirement
1. Quality of life – I feel comfortable…
with where I currently live
Unsure/No
1
2
3
4
Yes
with the level and regularity of my savings
Unsure/No
1
2
3
4
Yes
with my financial situation and it does not worry me
Unsure/No
1
2
3
4
Yes
that my financial situation does not worry my spouse/partner
Unsure/No
1
2
3
4
Yes
with my spending habits
Unsure/No
1
2
3
4
Yes
with my partner/spouse/dependents spending habits
Unsure/No
1
2
3
4
Yes
that I pay off credit cards each month
Unsure/No
1
2
3
4
Yes
that I will be able to acquire the new ( fill in the blank ) that I desire
Your answer
2. Retirement – I have…
determined how much I need to save for a comfortable retirement
Unsure/No
1
2
3
4
Yes
determined when I can afford to retire
Unsure/No
1
2
3
4
Yes
defined goals for my retirement years
Unsure/No
1
2
3
4
Yes
prioritized those retirement goals
Unsure/No
1
2
3
4
Yes
3. Other life events – I currently have a plan as to how to…
purchase my next car without borrowing
Unsure/No
1
2
3
4
Yes
fund my children’s education
Unsure/No
1
2
3
4
Yes
fund my grandchildren’s education
Unsure/No
1
2
3
4
Yes
help my family in ways I desire
Unsure/No
1
2
3
4
Yes
fund my children’s wedding(s)
Unsure/No
1
2
3
4
Yes
4. Investments – I am confident…
my investments adequately reflect my risk tolerance/capacity
Unsure/No
1
2
3
4
Yes
my investments are properly diversified
Unsure/No
1
2
3
4
Yes
that I have a “plan” for my investments (Investment Policy Statement)
Unsure/No
1
2
3
4
Yes
I know how the costs and fees impact my portfolios performance
Unsure/No
1
2
3
4
Yes
my portfolio has the highest return for the risk I am willing to take
Unsure/No
1
2
3
4
Yes
in the investing I have done to date
Unsure/No
1
2
3
4
Yes
5. Risks - I am certain that I am adequately protected…
if my home were to burn to the ground
Unsure/No
1
2
3
4
Yes
if I were to be sued for a huge liability
Unsure/No
1
2
3
4
Yes
if I became unable to work
Unsure/No
1
2
3
4
Yes
in the event of a health treatment costing $3 million
Unsure/No
1
2
3
4
Yes
in case of a 4 year long-term care stay when I’m age 80
Unsure/No
1
2
3
4
Yes
if I died prematurely, my family would be financially taken care of
Unsure/No
1
2
3
4
Yes
6. Estate Planning – I am certain that my current estate planning documents will…
safeguard my minor children at my death
Unsure/No
1
2
3
4
Yes
minimize estate tax as much as legally possible
Unsure/No
1
2
3
4
Yes
not require modification when the Estate Tax laws change
Unsure/No
1
2
3
4
Yes
make it difficult to have my final wishes disputed by others
Unsure/No
1
2
3
4
Yes
make transfer of assets to my heirs as effortlessly as possible
Unsure/No
1
2
3
4
Yes
keep estate administrative costs as low as possible
Unsure/No
1
2
3
4
Yes
make it easy for me to be cared for if I become incapacitated
Unsure/No
1
2
3
4
Yes
assure my life support decisions will be followed without a legal battle
Unsure/No
1
2
3
4
Yes
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