Please fill out the financial health assessment as completely as possible. The purpose of this assessment is to assess your overall financial well-being and let you know what other avenues you may need to take. Thank you.

OVERVIEW...

I currently have adequate life insurance. (required)

I currently have adequate health insurance. (required)

I have a retirement plan. (required)

I have auto-insurance. (required)

I have created a spending plan for my household. (required)

I balance my checkbook every month. (required)

I consistently save at least 5% of my paycheck each month. (required)

I am currently satisfied with my level of income. (required)

I have a good sense of my relationship with money. (required)

YOUR THOUGHTS...

I have a good sense of my relationship with money. (required)

Imagine the kind of life you’d like to live. Do you have a level of income that sustains that type of lifestyle? Are you currently living that lifestyle? (required)

If you’re not living the life you’ve imagined for yourself, what can you do to accomplish that goal? (required)

Do you have unsecured debt such as credit cards, store cards, etc…? How do you feel about your level of unsecured debt? Overwhelmed? Frustrated? Satisfied? Explain in detail. (required)

Are you comfortable speaking to your spouse/partner about your current debts? (required)

Have you discussed all of your debts with your current spouse or partner? (required)

Do you feel that debts from your past relationship(s) are causing problems in your current relationship? (required)

Are there things you would you like to change about your current debt situation? (required)

YOUR GOALS...

Please list your short term goals: (required)

Please list your long term goals: (required)

YOUR BUDGET...

Have you prepared a budget in the past 6months? (required)

Do you feel that your budget working for you? (required)

Are you having difficulty staying within your budget? (required)

Have you had recent (6 month) changes to yours or your spouse/partners income? (required)

Do you currently use any financial tools, such as a budget tracker, to improve your budget? (required)

CREDIT REPORT...

Have you recently (60 days) reviewed a copy of your credit report? (required)

Are you aware that you can receive a free copy of your credit report? (required)

Would you like all 3 credit reports for free? (required)

If you have your credit report, are you satisfied that all of the information on the report is correct? (required)

Are there things that you would like to change on your credit report? (required)

Has information on your credit report affected you in the past? (required)

Do you think information on your credit report will affect your future plans? (required)

Have you ever had help reviewing the information contained in your credit report? (required)

REQUEST HELP...

I am interesting in getting a free consultation from an agency about one or more of the following services - Tax Settlement, Bankruptcy, Loan Modification, Foreclosure Assistance, Credit Repair, Auto-Loan Modification, Student Loan Consolidation, Debt Settlement.
Please enter one or more of the services you may be interested in:

Please enter your Full Name (required)

Email Address (required)

Please enter your phone number (required) Enter as 000-000-0000

Company Name