Name *

First Name

Last Name

Phone *

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Do you have a will/trust/estate plan? *

Yes

No

Have you reviewed your estate plan in the last 24 months? *

Yes

No

Have you organized all your important information in one location for easy access? *

Yes

No

Does a trusted family member or friend have access to your passwords and important information? *

Yes

No

Do you have a care plan for aging?

Yes

No

Do you have adequate financial resources to enjoy your desired quality of life throughout your entire life expectancy? *

Yes

No

Do you have a personal long-term care policy, or other resources, to cover extended medical and living aid expenses?

Yes

No

If a medical emergency occurred, and you were unable to speak for yourself, have you empowered someone to speak for you? *

Yes

No

Do you have a budget for investing in personal development for you and your family? *

Yes

No

Does your family know and trust your advisors (CPA, attorney, financial planner)? *

Yes

No

Have you defined how you want to experience life, be remembered, and want to leave behind? *

Yes

No

Do you have a system to prepare future generations to answer YES to the questions above? *

Yes

No