Personal Blueprint Form All fields that have the * symbol are required. General Information Client Name(s) * Telephone Email * Personal Blueprint To help us clearly understand your current situation, please complete the Personal Blueprint. Rate your reactions to each pair of phrases by deciding where you lie on a scale of 1-10. Your responses will be submitted to an advisor. All questions are required. Please click submit once completed. 1 = Not Confident 10 = Confident I have set any clear goals for my financial future * 1 - Not Confident2345678910 - Confident I have a written strategic financial plan in place * 1 - Not Confident2345678910 - Confident I will have sufficient funds at retirement * 1 - Not Confident2345678910 - Confident In the event of my untimely death, my family will be financially okay * 1 - Not Confident2345678910 - Confident In the event of a medical condition, I do have the financial resources readily available to seek out the best treatment in the world * 1 - Not Confident2345678910 - Confident If I became disabled for a period of time, my coverage is adequate and our lifestyle would not suffer greatly * 1 - Not Confident2345678910 - Confident I have prepared well for my child's education plans * 1 - Not Confident2345678910 - Confident I do budget my cash flow well and find it difficult month to month * 1 - Not Confident2345678910 - Confident My assets will be passed in the most effective way possible to my heirs * 1 - Not Confident2345678910 - Confident I am happy with the financial advice I have received from my other Advisor * 1 - Not Confident2345678910 - Confident Advisor Name* Select an AdvisorMike TaltyChad ViminitzJon CraigDoug RocheCam D. Trahan I have read and agree to the terms in the privacy policy. Personalized Form ListLife Insurance Blueprint Form Personal Blueprint Form Client Risk Profile Form Client Profile Form Business Blueprint Form