Romaine Edwards
Financial Needs Analysis — Intake
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First Name
*
Last Name
Phone
*
Email
*
Marital status
— Choose —
Single
Married
Partnered
Divorced
Widowed
Do you have children or other dependents?
— Choose —
No
Yes — 1
Yes — 2
Yes — 3 or more
Occupation
Are you a business owner?
— Choose —
Yes
No
Do you own or rent your home?
— Choose —
Own
Rent
Other
Do you currently have life insurance?
— Choose —
Yes — through work
Yes — personal policy
Both
No
Not sure
Are you saving for retirement today?
— Choose —
Yes — regularly
Sometimes
Not yet
Not sure
What's your biggest financial priority right now?
— Choose —
Protecting my family's income
Paying down debt
Saving for retirement
Buying a home
Building wealth
College funding
Creating a legacy
I'd like a full financial checkup
What are your top financial goals for the next 5 years?
Best day/time to connect
Anything else you'd like me to know?
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