First Name

Last Name

Phone *

Email *

Age *

Profession *

Chiropractor

Physiotherapist

Registered Massage Therapist

How did you hear about us?

What is your gross annual income? (Before taxes) *

< $50K

$50K - $100K

$100K - $150K

$150K - $200K

$250K

What is your approximate net worth? (Assets - Liabilities) *

< $50K

$50K - $250K

$250K - $500K

$500K - $1M

$1M+

On a scale of 1 to 5 (5 = highest), how confident are you with your finances? *

1 (Not Very Confident)

5 (Very Confident)

What are your top 2 personal financial goals? *

Another goal

What are your top 2 financial/tax challenges? *

Another Challenge

Do you currently hold a student loan? *

Yes

What did you learn about money while growing up? *

Based on your tax situation, do you know if either RRSP or TFSA is better for you? *

Yes

Have you maxed either your RRSP or TFSA? Please describe: *

Yes

Describe here *

Do you have anyone that depends on you financially? *

Yes

Do you have adequate insurance to protect your potential income loss? *

Yes

Please describe what you are currently doing to minimize your taxes payable *

Are you aware insurance can help you save taxes? *

Yes

How would you like to distribute your money when you pass away? *

Are you aware of the benefits of incorporating? *

Yes

Are you aware that RRSP and money in your company will become part of your estate and taxed up to 53.5%? *

Yes

If you are incorporated, how are you currently taking money out of your corporation for personal use? *

Dividend

Shareholder Loan

Salary

Others

Please Describe here *

Do you know the tax difference between active and passive income within a corporation? *

Yes

Did you know you can invest within a corporation, and use the money for retirement personally while being tax efficient? *

Yes

Not applicable to me

Do you have retained earnings that are not required for business operations? *

Yes

Is there anything else you'd like to learn? Please describe: *

Yes

Please describe here *

Client's Printed Name *

Client's Signature *

Clear

Date *

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