Questionnaire | Grounded Financial

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QUESTIONNAIRE

Welcome to Grounded Financial Coaching!

We’re excited to help you on your journey toward financial empowerment. Please take a few moments to fill out this questionnaire so we can better understand your needs, goals, and where you currently stand on your financial journey. Your responses will allow us to tailor our coaching services to your unique situation.

Personal Information

*Full Name:

*Email:

*Phone:

*Occupation:

*Marital Status:

*Dependents:

Financial Overview

*What is your current monthly income (after taxes)?

$0 - $2,000

$2,000 - $5,000

$5,000 - $10,000

$10,000+

*Do you currently have any form of savings or emergency fund?

Yes

No

If yes, how much have you set aside?

*What is your total monthly debt (including mortgage, student loans, credit cards, etc.)?

*What are your current monthly living expenses (housing, utilities, groceries, transportation, etc.)?

Do you have any investments (stocks, bonds, real estate, etc.)?

Yes

No

If yes, what types and approximate values?

Financial Mindset

*How would you describe your current mindset around money? (Please select your answer)

Scarcity (I feel like there’s never enough money)

Stability (I feel in control but have room for improvement)

Abundance (I feel confident and empowered in my financial choices)

*What are your greatest financial concerns at the moment? (Please select your answer)

Debt

Lack of savings

Inability to invest

Unexpected expenses

Other

If other, please specify.

*How confident do you feel about managing your finances on a scale of 1 to 10?

*What do you believe has been your biggest obstacle in reaching your financial goals?

Financial Goals

*What financial goals are you currently working toward?

Paying off debt

Saving for an emergency fund

Building wealth through investments

Purchasing a home

Preparing for retirement

Other (please specify)

Select all that apply

If other, please specify.

*In the next 12 months, what would you like to achieve financially?

*What are your long-term financial goals (5+ years)?

Coaching Expectations

*What specific areas of financial coaching are you most interested in? (Please select your answer)

Budgeting and debt management (Tier 1)

Investment strategies and wealth building (Tier 2)

Both

Other (please specify)

If other, please specify.

*Have you worked with a financial coach before? If so, how was your experience?

*What do you hope to gain from our coaching sessions?

Commitment and Accountability

*How much time can you realistically commit each week to improving your financial situation?

*On a scale of 1 to 10, how committed are you to making the changes necessary to achieve your financial goals?

Do you have any questions or concerns you’d like to discuss during our initial session?

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