ACORN CONSULTING

PERSONAL SURVEY FORM INSTRUCTIONS: Personal Financial Planning means different things to different people. For some it means getting a better handle on cash flow and managing money, while others want to make more informed decisions based on sound financial principles, still others have immediate concerns that require specialized knowledge or capabilities not at their disposal. This personal survey form is designed to help us determine whether personal financial planning is likely to be beneficial and cost effective for you. There are two parts to this form. When answering the questions in Part A please explain your responses and answer all questions as best you can. If a question does not pertain to your situation or concerns, please so indicate. The questions in Part B will provide us with the necessary personal information and identify the advisers you are currently working with.

Name *
Name
CLIENT:
SPOUSE:
Life insurance policies?
Disability income policies?
Excess liability (umbrella) policy?