Tell Us About You – Johnson Financial Insight

Full Name

First

Last

Email Address

Contact Number

How did you hear about Johson Financial Insight?

You personally know me

Word of mouth

Social media

Have you ever worked with a Financial Coach before?

Yes

No

How many people are you financially responsible for?

What is your current annual take-home pay range?

Below 20 thousand dollars

20 to 30 thousand dollars

30 to 45 thousand dollars

45 to 70 thousand dollars

70 to 100 thousand dollars

Over 100 thousand dollars

What is your occupation?

What is your current pay structure?

What are you hoping to gain from financial coaching?

List your current household debts below, with as much detail as possible.

What are your top three (3) goals?

Are you willing to invest in your financial future?

Yes

No

I am not sure, I still have questions

Are you ready to make a change in the way you handle your money? Are you aware that this will take changing your spending habits, patience, accountability, practice, open communication, and having an open mind?

Yes

No

Maybe this isn’t for me, but I have some questions

What legacy would you like to leave behind?

What is one thing you love to do?

Anything extra you would like me to know?