Full Name *

Phone *

Email

Idioma/Language

Español

English

Preferencia de comunicación/Preference

Telefono/Call

Texto/Text

Correo Electronico/Email

Social/Whats App

How Did you Hear about us? *

Walk In

Referral

Social Media

Website

Google

Event

Flyer

Other

Source

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Let's Learn About You

What Brings You In Today? (Client 's Words)

What is your timeline for this?

Immediately / ASAP
Next 2 Weeks
Next 30 days
Next Few Months
Within 12 months
1+ Years
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Why/Reason Behind this/Need/Additional Info?

Aliado Notes:

How does client feel about their situation right now?

Very Unstable
Somewhat Stable
Mostly Stable
Very Stable
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Immediate Concerns

Housing

Income / Job

Food Essentials

Medical

Family

Business

Insurance

Immigration

Other

None

Legal Status?

Bad - no docs, not started
ok - no docs, in process
Good - have docs
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List is empty.

Income

Current Source of Income

Job

Business

Investments

Family

Gov. assistance

Soc. Sec / Disability

Other

None

Monthly Income

$

Do/Have You Files Taxes?

Yes, up to date
Yes, but behind
No, Dont file
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ITIN or Social Security?

ITIN
Social Security
None
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Need Help with Taxes?

Yes

No

Credit & Debt

Credit Condition

Bad
Ok
Great
Don't Know
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Credit score if known

Do you want to improve it/Credit Repair?

Yes

No

Unsure

Is Debt a Problem?

Yes, too much
Yes, but not too much
Not a Problem
No Debt
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Total Debt Amount:

$

Monthly Debt Payments"

$

Do you want to reduce debt?

Yes

No

Indifferent

Need or Want Loan?

Yes

No

Type of Loan Needed:

Personal

Car

Mortgage

Business

Credit Card

Other

Amount of Loan Needed

$

Assets

Assets Currently Owned or Being Built

Home / Real estate

Business

Savings

Investment Accounts

Retirement Account

Other

Which Asset Protection / Insurances do you have?

Home / Renters

Liability (Business)

Life

Health

Auto

Medicare

Long Term Care

Other

Needs Insurance?

Yes

No

What Estate Planning Protection do you have?

Trust

Will

Advance Life Directive

Final Expenses / Funeral

Needs Estate Planning?

Yes

No

Goals

What is your Main Goal?

Buy Home / Real estate
Start / Grow Business
Improve Credit
Reduce Debt
Immigration Status
Job / Increase Income
Increase Savings / Investments
Other
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Main Goal Notes

Timeframe

Immediately / ASAP
2 weeks
next 30 days
6 months
12 months
1+ Year
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Secondary Goals

Buy Home / Real Estate

Start / Grow Business

Improve Credit

Reduce Debt

Immigration Status

Job / Increase Income

Increase Savings / Invesments

Other

Secondary Goal Notes:

2-5 Year Vision

Assessment

Primary Root Cause / What they Need Most

Can We Help Them?

Yes

No

Unsure Yet

Stability Risk Level

Very Unstable
Unstable
Stable
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Emotional Indicators Observed

Overwhelmed

Confused

Fearful

Motivated

Relieved

Distrustful

Positive

Negative

What Partners / Services Will They Need?

Real Estate

Mortgage

Business

Other Lender

Insurance

Financial Advisor

Estate Planning

Health

Tax

Church / NonProfit

Government

Immigration

Attorney / Legal

Staffing / Job

Credit Repair

Debt Couseling

Most Likely Persona

Planter
Weed Wacker
Sprout
Bloomer
Harvester
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Assessment Notes

Recap / Summary / Notes

Aliado

Signature

Date

Diagnosis Complete?

Yes

No

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