Financial Satisfaction Survey
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Name *
Email *
Cell Phone *
Address *
Name of Company *
Company Website *
How did you hear about Justin Krane? *
I am an: *
If I am an owner of my own business, or act as an Independent Contractor, my business grosses $ in Annual Sales *
Directions: The statements below will help you to think about and assess how satisfied you are with many aspects of your financial life. Select and record your level of satisfaction for each statement.
I am satisfied…
1. …with my ability to meet my financial obligations.
(Not Satisfied)
(Satisfied)
Clear selection
2. …with the income my current job or business provides me.
(Not Satisfied)
(Satisfied)
Clear selection
3. …with my spending habits.
(Not Satisfied)
(Satisfied)
Clear selection
4. …with the level of debt I carry.
(Not Satisfied)
(Satisfied)
Clear selection
5. …with the “extras” that I am able to buy for myself or loved ones.
(Not Satisfied)
(Satisfied)
Clear selection
6. …with the level and quality of insurance protection I currently have.
(Not Satisfied)
(Satisfied)
Clear selection
7. …with the amount of money that I save and invest on a regular basis.
(Not Satisfied)
(Satisfied)
Clear selection
8. …with my current investment choices.
(Not Satisfied)
(Satisfied)
Clear selection
9. …that I am on track to build a sufficient retirement nest egg.
(Not Satisfied)
(Satisfied)
Clear selection
10. …with the level of employee benefits I receive.
(Not Satisfied)
(Satisfied)
Clear selection
11. …with my style of personal bookkeeping and financial record management.
(Not Satisfied)
(Satisfied)
Clear selection
12. …with my ability to provide financial help to my family members.
(Not Satisfied)
(Satisfied)
Clear selection
13. …with my estate plan.
(Not Satisfied)
(Satisfied)
Clear selection
14. …with my level of charitable giving.
(Not Satisfied)
(Satisfied)
Clear selection
15. …with the level of financial education I have attained.
(Not Satisfied)
(Satisfied)
Clear selection
16. ...with how I respond emotionally to my personal financial issues.
(Not Satisfied)
(Satisfied)
Clear selection
17. …with my ability to communicate about my financial matters.
(Not Satisfied)
(Satisfied)
Clear selection
18. …with the feelings I have about my money life.
(Not Satisfied)
(Satisfied)
Clear selection
19. …that financial issues do not cause stress or strain in the relationships that are important to me.
(Not Satisfied)
(Satisfied)
Clear selection
20. …with the working relationships I have with my financial service providers (i.e., insurance agent, banker, broker, financial planner, accountant).
(Not Satisfied)
(Satisfied)
Clear selection
That's it! You're done!  Just click submit, and someone at Krane Financial Solutions will get in touch with you!
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