Financial Residency - Financial Health Assessment
Thank you for your interest in having a FREE on-air financial assessment reviewed on our podcast! Please fill out the following form to get us the data we need from you. If you have any questions, reach out to me at and I'll help you any way I can.

Pssst - Don't use your real names :)
Email address *
What names would you like to use on the show? *
What is your speciality or field? If you have a partner, what is their occupation? *
How old are you? If you have a partner, how old are they? *
Family Status? *
Do you have kids? *
Describe your current living situation (3-5 sentences) *
What are your top 5 goals that you (or both of you) want to accomplish? *
What is your annual income and/or take home pay? Please break it out individually if you are a couple. *
Please provide a breakout of your expenses. I'm looking for, what are your fixed expenses (ex: rent/mortgage, bills etc.) and what are your variable expenses (Amazon, clothes, dining out etc.) *
How much do you currently save per month? *
What do your investments look like? What type of accounts, estimate on how much is in there, ballpark of what you are invested in, etc. (Ex: have a roth IRA, $15,000 balance, invested in 80% stock, 20% bonds) *
Where do you currently bank? What is the structure? (ex: one checking, two savings) What are the accounts used for primarily? *
Do you have student debt? If so, what is your current plan, how much, what is the interest, etc. Are you going for PSLF? *
What other debts do you have? Please be specific as possible. (ex: have credit card debt, $10,000 at 20%; only making minimum payments of $75/mo) *
Do you have umbrella insurance? *
What forms of insurance do you have? Please list everything as well as the premiums per year. (ex: have 20 year term insurance for $1m and cost is $1000/yr) *
How do you file your taxes? *
Do you have any estate planning documents? *
If yes, what do you have? (ex: will, power of attorney, healthcare directive, living trust) *
After you click submit, you will be emailed a copy of your answers. Please visit where you can leave me a "voicemail". With the answers in hand, please click record and read out loud your answers. Don't worry if you make a mistake, we can edit anything out. Just be yourself and read out loud all of the answers you just wrote. This will be used in the show. *
I will send you an email when the show will go live to the email address you listed here. Please confirm by putting your email in this response. *
Please acknowledge that anything said on the Financial Residency podcast is general in nature, shouldn't be considered investment or actual planning advice and should be viewed as entertainment purposes only. *
Would you be interested in hearing more about how I work with physicians and their families? If so, you can book a free introductory call at *
A copy of your responses will be emailed to the address you provided.
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