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Services
Tax Preparation
Home Loans
Personal Finance Coaching
About Us
Meet Chad
Meet Emilie
Chad's Story
Client Resources
Tax Resources
Home Loan Resources
Financial Coaching Resources
E-News
Client Reviews
Contact Us
Search by typing & pressing enter
YOUR CART
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Indicates required field
Name
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First
Last
Email
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Date of Birth
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What was your immediate reaction to the intro recording we sent you? What thoughts and feelings came to you?
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Why are you interested in Financial Coaching? What are your expectations of what you'll gain from this process (financial and non-financial)? Use this space to describe your CURRENT financial coaching needs.
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YOUR PAST
1) When you were a child, what did you want to be when you grew up?
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2) Did you learn about money from your parents while you were growing up?
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Yes
No
If yes, briefly describe what you learned.
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3) Did you learn about money from schooling/education while you were growing up?
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Yes
No
If yes, briefly describe what you learned.
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4) Did you learn about money anywhere else while growing up?
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Yes
No
If yes, briefly describe what you learned (and from where).
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5) Which of the following describes how you learned to manage your personal finances? (select ALL that apply)
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My parents proactively taught me
I observed my parents' struggle and vowed to learn from their mistakes
I observed my parents' success and wanted to achieve the same success they did
I proactively learned through reading, studying, etc.
I re-actively learned through trial and error as I moved through life
6) Which best describes your recollection of how your parents handled finances when you were growing up?
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They never talked about it
They rarely discussed money
They consistently argued/fought about money
They frequently talked about money peacefully
7) What problems have you encountered in past relationships, as it pertains specifically to money?
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8) Looking back on your life, what would you say are the biggest financial mistakes you have made and what did you learn from them?
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9) When was the last time you spent money and instantly regretted it? What did you purchase? Why did you regret it?
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10) Have you been married before?
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Yes
No
If yes, how was your relationship as it relates to finances?
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If yes, did you keep your money separate, or join all money together as one?
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11) When was the last time you INVOLUNTARILY missed work without pay? (i.e. - laid off, fired, health issues, etc.)
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Never
< 1 year ago
1 - 2 years ago
> 2 years ago
12) How long did you miss work?
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< 3 months
3 - 6 months
6 months - 1 year
> 1 year
Not applicable
13) Which of the following financial setbacks have you faced in the last 20 years? (select ALL that apply)
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Divorce
Health Problems
Natural Disaster (fire, flood, earthquake, etc.)
Loaned Money out that was not repaid to you
Home Foreclosure or Car Repossession
Bankruptcy
None of the above
14) When was the last time you paid interest as a result of not paying off a credit card in full?
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Within the past Month
Within the past Year
More than 1 Year ago
Never
15) Which of the following have you experienced due to your current financial situation? (select ALL that apply)
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Loss of sleep
Stress & anxiety
Depression
Marriage conflict (out of the ordinary)
YOUR PRESENT
1) Are you currently in a relationship?
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Yes
No
2) Do you have any children?
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Yes
No
If yes, list names and ages below.
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If yes, do your children live with you?
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Yes
No
If yes, have you had any discussions with your kids about money?
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Yes
No
If yes, briefly describe your interactions.
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If no, do you plan on having children in the future?
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If you plan on having children in the future, how many?
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1
2
3 or more
3) Do you have aging parents who rely on you for financial support?
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Yes
No
4) Are you comfortable discussing your finances with others?
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Yes
No
If yes, who? (i.e. - family, friends, strangers, etc.)
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5) Do you have any professional advisors (tax preparer, attorney, financial advisor, money manager, insurance agent, etc.)?
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Yes
No
If yes, list advisor types and your rating of this pro (names not necessary)?
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6) Do you lose sleep at night thinking about your finances?
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Yes
No
7) How often do you actually sit down to review your finances, from a planning perspective?
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Monthly or Quarterly
Semi-Annually
Annually
Less than Annually
Not applicable (I'm not married)
8) How much time would you say you spend on an average month viewing and paying bills?
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Does the above process cause you anxiety or stress?
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Yes
No
9) Do you log transactions into an account register so you know your current balance?
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Yes
No
10) Do you reconcile ALL credit card and bank account transactions, by comparing your data with what your institutions show?
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Yes
No
11) Briefly describe 2 things in life you are truly passionate about (i.e. - Chad Peshke's passion is Changing Lives by helping people Make Finances Simple)
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12) If you already had all of the money you ever wanted, what would you do differently? In other words, what would you be doing in life if money was not a factor?
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13) If you were given $100,000 tomorrow, what would you do with the money?
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14) If you were given $500 tomorrow, what would you do with it?
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15) Which best describes your first financial thought when a mechanic says you need new brakes?
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There is no way I can afford this right now
I'm glad I planned ahead for things like this
16) Does your employer provide matching for retirement savings (401k, etc.)?
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Yes
No
If yes, provide details below.
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17) Does your employer provide a pension for your retirement
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Yes
No
If yes, provide details below.
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18) How do you generally handle finances when "it rains & pours"? (i.e. - car breaks down just after your home air conditioning unit blows out while your daughter needs money for senior prom)
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I have to use a credit card that I can't pay off in full when the bill comes due
I have money in the bank to completely pay for these situations
19) What total do you have in Savings solely for EMERGENCIES? (i.e. - money you could quickly access without penalty)
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< $5,000
$5,001 - $10,000
$10,001 - $25,000
> $25,000
20) What percentage of your income do you give away to your church and/or other causes?
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0
1 - 5%
6 - 10%
> 10%
Do you desire to or wish you could give more?
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Yes
No
21) What percentage of your income is currently being invested for retirement? (i.e. - 401k, IRA, etc.)
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0
1 - 5%
6 - 10%
> 10%
22) Are you currently saving for your child's college education?
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Yes
No
I don't have children
23) Do you own your primary home?
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Yes
No, but I own rental real estate
No, I don't own any real estate
24) Other than home loans, what types of debt do you currently have? (select ALL that apply)
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Auto loan(s)
Student/Education loan(s)
Credit card debt
Personal/Bank loan(s)
Other
None
25) What is the total amount owed on the debts mentioned above?
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< $25,000
$25,001 - $50,000
$50,001 - $100,000
> $100,000
Not applicable (I don't have debt other than home loans)
26) Do you have any looming pressing financial need that needs to be taken care of in the next year? (i.e. - new car, adjustable home loan, etc.)
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Yes
No
27) Is there anything happening in your life, right now, that could have a major impact on your financial future?
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Yes
No
28) Have you ever borrowed from (or lent money to) a family member or friend?
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Yes
No
If yes, how did it affect your relationship?
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29) Have you ever participated in “get-rich” schemes to quickly make up ground on improving your financial situation? If yes, briefly describe below.
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Yes
No
30) How many credit cards do you have? (include joint cards)
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0
1 - 2
3 - 5
> 5
31) Why do you feel the need to have a credit card? (select ALL that apply)
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So I can buy things with money I don't have
In case of an emergency...for protection
To earn cash back/points rewards on everyday purchases
For business expense tracking
To be eligible for retailer/merchant discounts
I don't have a credit card
32) Which best describes your mentality when on vacation as it relates to money?
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I don't think about money when I'm on vacation...life is too short
I shouldn't be on this vacation...I can't really afford it
I really don't have the money for this vacation...but I work hard and deserve it
Glad I budgeted for this vacation so I know I have the money to pay for it
33) Which best describes your guilt level when making a purchase you aren't sure you can truly afford?
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Life is too short and I work hard...so I don't worry about it
I feel initial guilt...then I purchase the item anyway
I try to be frugal & keep spending to a minimum
I don't buy things that aren't in my budget
34) Do you feel pressured to adhere to societal standards as far as what you own? (i.e. - best house, nicest car, clothes, jewelry, etc.)
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Yes
No
35) Rate your level of happiness with your current financial position
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100% happy
Content...but would still like to improve
Not very happy
Depressed
36) Are you happy at your current job?
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Yes
No
Why or why not?
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37) Are you fulfilled with the work you are doing at your current job? Why or why not?
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38) What is your dream job/career?
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39) How would you feel if you lost your job tomorrow? What would be the ramifications for you, financial and non-financial?
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40) How is your physical health?
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Great
Good
Fair
Poor
41) How are your finances currently affecting your health?
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A Lot
Sometimes
Rarely
Not at all
42) What’s currently missing in your life? Where do you feel a voice (financial and/or non-financial)?
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YOUR FUTURE
1) What worries you about your future?
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2) What major purchases do you anticipate in the next five years? If any, provide more information below.
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3) Does anybody in your family (who depends on you financially) have a medical condition or other situation that would impact you financially?
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Yes
No
If yes, please explain below.
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4) Do you plan on paying education expenses for any children or dependents?
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Yes
No
If yes, provide more info below.
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5) At what age do you wish to retire?
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65
60
55
Younger
6) Briefly describe your definition of retirement.
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7) Write down 2 specific FINANCIAL goals you hope to achieve in the next 2 years
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8) Write down 3 specific FINANCIAL goals you hope to achieve in the next 10-15 years
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9) Which 3 choices below do you mostly want to improve with your finances? (select ONLY 3)
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More income
Lower monthly debt payments
Less overall debt
More savings
Higher retirement
More "fun" money (for vacation, entertainment, etc.)
Other
10) Write down 2 LIFE goals (non-financial) of yours that money can help you achieve
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Submit