Everlast Wealth — Financial Planning Intake

1

Call & Administrative Info

Log call details before the conversation begins.

Date of Call

Agent Name

Agent Email

Source / Campaign

CRM Opportunity Name

Referral from Existing Client?

Referred By (if yes)

2

Client Basic Information

Core contact and household details.

Primary Client

Full Name

Date of Birth

Phone

Email

Driver's License #

Physical Address

Mailing Address (if different)

Co-Client / Spouse

Full Name

Date of Birth

Phone

Email

Driver's License #

Relationship to Primary

Marital Status

Single Married Divorced Widowed Dom. Partner

Preferred Contact Method

Call Text Email

Best Time to Reach

Number of Dependents

Ages of Dependents

2b. Health Screening

Primary Client

Health Rating (1 = Poor, 10 = Excellent)

Poor Fair Good Very Good Excellent

Tobacco / Nicotine Use?

No Yes — Current Former

Type / Frequency (if yes) / Quit Date (if former)

Chronic Conditions / Medications

Co-Client

Health Rating (1 = Poor, 10 = Excellent)

Poor Fair Good Very Good Excellent

Tobacco / Nicotine Use?

N/A No Yes — Current Former

Type / Frequency / Quit Date

Chronic Conditions / Medications

Family History of Major Illness?

None Yes — describe below

3

Income

Gross annual income for each earner. Additional / passive sources below.

Primary Client

Occupation / Title

Employer

Annual Gross Income ($)

Years Employed

Co-Client

Occupation / Title

Employer

Annual Gross Income ($)

Years Employed

Additional / Passive Income

Sources (check all that apply)

Rental Income Business Income Social Security Pension Dividends Disability Alimony / Child Support Other

Describe additional sources & monthly amounts

Employment Status — Primary

Employment Status — Co-Client

Income Stability

Expected Income Changes?

Self-Employment / Business Notes

4

Debt Obligations

All current debt — mortgage, vehicles, cards, loans.

Debt Type / Creditor Total Owed ($) Monthly Pmt ($) Rate (%) Notes

Type / Creditor

Total Owed ($)

Monthly ($)

Rate (%)

Notes

Type / Creditor

Total Owed ($)

Monthly ($)

Rate (%)

Notes

Type / Creditor

Total Owed ($)

Monthly ($)

Rate (%)

Notes

Accounts in Collections?

Behind on Any Payments?

Wage Garnishments?

Lawsuits or Judgments?

Debt Management Goal

Debt Eliminator Plan in Place?

5

Monthly Expenses & Liquid Reserves

Exclude debt payments captured in Section 4.

Total Monthly Expenses (est. $)

Annual Expenses (est. $)

Key Expense Categories & Notes

Current Monthly Surplus ($)

Monthly Amount to Set Aside for Goals ($)

Liquid Reserves

Checking / Savings Total ($)

Emergency Fund (# months covered)

Other Liquid Accounts (describe & amount)

6

Existing Insurance Coverage

All in-force life, disability, LTC, and health policies including employer-provided coverage.

Policy Type

Carrier

Benefit Amt ($)

Ann. Premium ($)

Living Bene?

Expiration

Beneficiary

Policy Type

Carrier

Benefit Amt ($)

Ann. Premium ($)

Living Bene?

Expiration

Beneficiary

7

Investments & Retirement Accounts

All investment and retirement accounts. Approximate balances are fine.

Account Type

Owner

Institution

Monthly Contrib ($)

Approx. Balance ($)

Notes

Account Type

Owner

Institution

Monthly Contrib ($)

Approx. Balance ($)

Notes

8

Retirement Planning

Goals, timeline, and income strategy for retirement.

Anticipated Retirement Age — Primary

Anticipated Retirement Age — Co-Client

Years Until Retirement

Est. Monthly Income Needed in Retirement ($)

Monthly Amount to Set Aside ($)

Retirement Income vs. Today

Same More Less

Investing Strategy & Tax Preference

Preferred Investing Strategy

Fixed Indexed Market

Guarantee vs. Growth Scale (1 = Guarantee, 10 = Max Growth)

Full Guarantee Max Growth

How Do You Want Retirement Income Taxed?

Now (annually) Later (deferred) Never Again (tax-free)

Survivorship Option

Single Joint

Expected Social Security Claim Age

Estimated SS Monthly Amount ($)

Pension Income Known?

Pension Monthly Amount ($)

9

Investment Profile & Risk Tolerance

Used to determine appropriate product fit and allocation strategy.

Investment Experience

No experience Basic (savings / CDs) Some (funds / ETFs) Experienced (self-managed)

If Portfolio Dropped 20%, Client Would…

Sell All Sell Some Hold Steady Buy More

Primary Investment Goal

Preserve Capital Steady Income Balanced Growth Max Long-Term Growth

Time Horizon

Less than 3 years 3–7 years 8–15 years 15+ years

Typically Receive a Tax Refund?

Yes No

Approx. Refund Amount ($)

Want to Leverage That Money Instead?

Any Investments / Sectors to Avoid?

10

Tax Situation

Filing status, income types, and key tax contacts.

Filing Status

Single Married Filing Jointly Married Filing Sep. Head of Household

Est. Federal Tax Bracket

State of Residence

Itemize Deductions?

Income Types (check all that apply)

W-2 / Salary Business / Self-Employed Rental Capital Gains RSUs / Stock Options Inheritance Social Security Pension Other

Significant Tax Events This Year

Attorney Name

Attorney Phone

Accountant / CPA Name

Accountant Phone

11

Estate Planning

Documents in place, beneficiary status, and estate concerns.

Documents in Place

Last Will & Testament

Living Trust

Power of Attorney

Healthcare Directive

Trust Type (if applicable)

Revocable Irrevocable Special Needs Charitable Remainder N/A

Pour-Over Provision?

Easy Legal Plan / Attorney on Retainer?

Beneficiaries Updated on All Accounts?

Estimated Total Estate Value ($)

Years Since Last Reviewed

Estate / Special Concerns

Important for Kids / Dependents to Understand Finances?

Will or Trust Established for Dependents?

12

Discovery Questions

Broad → Specific → Impact. Capture responses in the client's own words — these are the most important lines in the intake.

A. Broad — Big Picture

Question 1

"Tell me about what's most important to you financially right now. What does financial security look like for your family?"

Let them talk. Don't interrupt. Note exact phrases — use their words back to them later.

Question 2

"If something unexpected happened to you tomorrow — what would your biggest concern be for the people who depend on you?"

Income, mortgage, kids' future, business continuity? Note what they name first — it's their #1.

Question 3

"What does retirement look like for you? When do you envision it happening, and what does your ideal income in retirement look like?"

B. Specific — Gaps & Concerns

Question 4

"Do you currently have life insurance or disability coverage in place? How confident are you that it's sufficient?"

Follow up: "If your employer provides it — what happens to that coverage if you change jobs?"

Question 5

"If you became disabled and couldn't work for 3–6 months, how long would your savings last — and what would happen after that?"

Question 6

"Are there any major financial events on the horizon? Home purchase, business change, inheritance, upcoming retirement, kids heading to college?"

Bonus — Long-Term Care

"Have you ever watched someone go through a long-term illness or need extended care? How did that experience shape how you think about your own situation?"

Bonus — Tax Awareness

"Do you feel like you have a clear picture of how much you're paying in taxes — and whether there are strategies you might be missing?"

Bonus — Debt & Cash Flow

"If you could eliminate one financial burden tomorrow, what would it be — and how would that change things for your family?"

C. Impact — Priorities & Motivation

Question 7

"On a scale of 1–10, how urgent is it for you to close the gaps or get a plan in place?"

Not urgent Critical — needs action now

Question 8

"If we could solve [their primary concern] today — what would that mean for you and your family?"

Replace [their primary concern] with what they named in Q1 or Q2. Let them paint the picture.

Question 9

"Is there anything I haven't asked about that you feel is important for me to know?"

13

Planning Priorities

Rate each as H (High), M (Medium), L (Low), or — (Not Applicable). Ask client to call these out or select together.

Priority Area	Rating	Priority Area	Rating

14

Preliminary Planning Gap Checklist

Check all gaps identified during the call. Use as a case design summary.

Debt Coverage Gap

Income Replacement Gap

Missing / Insufficient DI

Missing LTC Coverage

V.I.T.L. Gap (CVLI)

Retirement Income Gap

Estate / Legacy Planning

Business Continuity

Beneficiary Review Needed

Health Insurance Gap

Tax Strategy Gap

College Savings Gap

Priority Order (1st Gap)

Priority Order (2nd Gap)

Priority Order (3rd Gap)

Gap Notes

15

Next Steps & Appointment Booking

Lock in the follow-up before ending the call.

Discovery Appointment Date

Appointment Time

Meeting Type

In-Person Virtual / Zoom Phone

Location / Meeting Link

Follow-Up Call Date

Follow-Up Call Time

Case Design Referral Triggered?

Warm Handoff / Referral to Notify

Reminder Sequence Triggered?

CRM Opportunity Created & Form Entered?

Agent Notes (Internal Use Only)

Submitted Successfully

Contact us

801-332-9670

925-699-4085

caleb@everlastwealth.com

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