Personal Information
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May we text you at this number? *
Yes
No
Are you a member of Element? *
Yes
No
Financial Situation
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Financial Goals
What are your short-term (within next 12 months) financial goals? Check all that apply.
Emergency Savings Fund
Debt Reduction
Budgeting and Expense Management
Credit Score Improvement
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What are your long-term (more than 1 year) financial goals? Check all that apply.
Home Ownership
Retirement Planning
Education Savings
Investment and Wealth Building
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Budgeting and Expenses
Do you currently have a budget in place? *
Yes
No
If yes, how do you track your expenses? Check all that apply.
Spreadsheet
Budgeting App
Pen and Paper
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What are your major monthly expenses?
Rent/Mortgage
Utilities
Groceries
Transportation
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Other Information
Do you have existing savings or investment accounts? Check all that apply.
401k
IRA
Brokerage Account
Crypto
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Do we have your permission to pull your credit report for your appointment? *
Yes
No
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Preferred Appointment Date
Monday - Friday (excluding federal holidays)
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Preferred Appointment Time
Appointment times begin at 8:30 am and end at 4:00 pm ET
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Preferred Appointment Location
Kanawha City - in person
South Charleston - in person
Zoom - virtual meeting
Your responses will remain confidential, and the information provided will be used solely for the purpose of your money wellness appointment. Thank you for taking the time to complete this questionnaire. Your responses will help us provide you with a more personalized and effective money wellness appointment.
Thank You!
We'll be in touch soon to follow up with your Money Wellness appointment.