Money Wellness Appointment

Personal Information

Your Name *

Email *

Phone # *

May we text you at this number? *

Yes

No

Are you a member of Element? *

Yes

No

Financial Situation

List any significant financial challenges or concerns you'd like to discuss during your appointment.

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

Other (please specify):

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

Other (please specify):

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

Other (please specify):

What are your major monthly expenses?

Rent/Mortgage

Utilities

Groceries

Transportation

Other (please specify):

Other Information

Do you have existing savings or investment accounts? Check all that apply.

401k

IRA

Brokerage Account

Crypto

Other (please specify):

Do we have your permission to pull your credit report for your appointment? *

Yes

No

List the topics you'd like to discuss during your appointment.

Preferred Appointment Date

Monday - Friday (excluding federal holidays)

Enter Date *

Preferred Appointment Time

Appointment times begin at 8:30 am and end at 4:00 pm ET

Enter Time *

Preferred Appointment Location

Kanawha City - in person

South Charleston - in person

The Element Edge - 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.