Client Intake Form Name First Name Last Name Email * Phone (###) ### #### Date of Birth MM DD YYYY Reason why you want to get clear on your finances now? Are you able to dedicate the next 3 months to putting in the work to unlocking your financial potential? Yes No Are you in a position to agree on the call to work together if it's a good fit? Yes No What's your belief about money? Never enough I always find a way to make it work I attract wealth like a queen Other What does good with money look like to you? Within your friend group how do you talk about money? Total Debt Student loans, credit card, mortgage, etc. $ Total wealth Savings, investments, gold stored under your bed, etc. $ Household Income before taxes $ Thank you!