Confidential Planning Questionnaire

Estate · Retirement · Healthcare · Legacy — 409.377.8060 · twlsgroup.com

Section 1 of 5 0%
1
Client Info
2
Estate Plan
3
Assets
4
Healthcare
5
Goals
Your information is strictly confidential

This form is used solely for financial and estate planning purposes by TWLS Group. Your responses are never sold, shared with third parties, or used for marketing. When you submit this form, your information is transmitted securely using industry-standard encryption and is received only by our team through Wealthbox, our secure, FINRA-compliant client management system.

Section 1 · Client & Family Information
Who are we planning for?
We start with your full legal names and family picture. Getting this right ensures beneficiary designations, legal documents, and account titling all match exactly.
Please fill in all required fields before continuing.
As it appears on your government ID
Please enter Client 1's first name.
As it appears on your government ID
Please enter Client 1's last name.
Spouse or co-client, if applicable
Spouse or co-client, if applicable
Please enter a valid phone number.
Please enter a valid email address.
Please enter a valid email address.
Leave blank if same as Client 1
Names, relationships, and dates of birth.
Section 2 · Estate Planning & Legal Documents
Do your documents reflect your wishes today?
Estate plans only work if they're current, coordinated, and properly funded. Our goal is alignment, not just paperwork in a drawer.
Yes
No
Yes
No
Not sure
Client 1 — Primary Beneficiaries Client 1 — Secondary (Contingent) Beneficiaries Client 2 — Primary Beneficiaries Client 2 — Secondary (Contingent) Beneficiaries
Legal Authorization Documents
Client 1
Client 2
Client 1
Client 2
Client 1
Client 2
Section 3 · Income & Assets
What does your financial picture look like?
Coordinating income and assets helps us manage taxes and long-term sustainability. We want to see what's reliable income versus what depends on markets.
Monthly Income (enter monthly amounts)
Client 1Client 2
Monthly Pension
Social Security
IRA / Retirement Withdrawals
Investment / Interest Income
Other Income
Total Annual Income
Primary Home
Additional Properties
Checking / Money Market / Savings / CDs / Bonds
Life Insurance Cash Values & Fixed / Fixed-Indexed Annuities
Mutual Funds / Stocks / Bonds / Variable Annuities
Section 4 · Healthcare & Long-Term Care
Protecting your health and your wealth
Long-term care costs average $40,000–$50,000 per year for custodial care not covered by Medicare. Over 50% of people will need some form of long-term care. Planning ahead now preserves your options.
Client 1
Client 2
Client 1
Client 2
General health questions — completely confidential — because health status affects planning options available.
Health QuestionClient 1Client 2
Cancer, heart attack, stroke, organ transplant, heart surgery, aneurysm, or kidney dialysis (past 12 months)
Alzheimer's, dementia, or cognitive impairment
HIV/AIDS or Acquired Immune Deficiency Syndrome
Difficulty obtaining life or health insurance in the past
Hospitalized in the past 5 years
Cancer, kidney disease, diabetes, leukemia, MS, paralysis, chest pains, heart/blood vessel disease, lung/liver disease, emphysema, stroke, or high blood pressure
Currently taking prescription medications or receiving medical treatment
Tobacco use in the past 12 months
Section 5 · Goals, Priorities & Acknowledgment
What does success look like for you?
Every great plan starts with clarity about the destination. We want to understand what matters most — not just financially, but what you want your life and legacy to look like.
Confidentiality Acknowledgment All information provided is strictly confidential and used solely for financial and estate planning purposes by TWLS Group and its affiliated advisors. This information will not be shared with third parties without your express written consent.
All done — ready to submit
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Your information is encrypted and sent securely — it goes directly to our team and nowhere else.