Date
Company Name
Contact Person
Job Title
Phone Number
Email Address
Company Address
City
State
Zip Code
Industry
Number of Employees
Do you have any existing wellness initiatives?
What are the current goals of your wellness program?
What are the perceived strengths and weaknesses of your current program?
What is the current budget allocated to the wellness program?
Please indicate which of the following financial planning assistance programs you are interested in offering to your employees. (Check all that apply)
Topics of interest:
Budgeting
Debt management
Retirement planning
Investment basics
Tax planning
Other:
Preferred format:
In-person
Virtual
Hybrid
Other:
Desired frequency:
Monthly
Quarterly
Annually
Other:
Preferred delivery method:
One-on-one meetings
Phone consultations
Online sessions
Other:
Desired level of personalization:
General advice
Comprehensive financial planning
Other:
Types of tools/resources desired:
Budgeting apps
Retirement calculators
Educational videos
Articles
Other:
Preferred platform integration:
Company intranet
Dedicated portal
Other:
Specific retirement plan assistance needed:
401(k) Education
Rollover assistance
Pre-retirement planning
Other:
Desired level of employee access to financial advisors:
Interest in programs focused on:
Card debt
Student loan debt
Other:
Desired program features:
Credit counseling
Debt consolidation guidance
Other:
Interest in ESOP or other equity compensation education:
Desired education focus:
Interest in implementing programs that encourage emergency savings:
Desired program features:
What are your primary goals for implementing a financial planning assistance program?
Increase employee financial well-being
Improve employee productivity and engagement
Reduce employee stress
Improve employee retention
Other (Please specify):
What is your desired level of employee participation in the program?
Voluntary
Encouraged
Mandatory (for specific groups)
What are your key performance indicators (KPIs) for measuring the success of the program?
What is your desired timeframe for implementing the financial wellness program?
What is your budget range for this program?
Are there any specific employee demographics or needs that should be considered when designing the program?
What are the biggest financial concerns you believe your employees have?
Is there any other information you would like to share?
Thank you for completing this form. We will review your information and contact you to discuss your financial planning assistance program options.
Form Template Insight
Please remove this form template insight section before publishing.
Let's break down the detailed insights into this client intake form, section by section, to understand its purpose and effectiveness:
1. Client Information:
Purpose: This section establishes the basic contact information for the client company. It ensures accurate communication and record-keeping.
Insights:
2. Current Corporate Wellness Program (if applicable):
Purpose: This section aims to understand the client's existing wellness initiatives. It helps identify gaps and opportunities for integration.
Insights:
3. Financial Planning Assistance Program Options:
Purpose: This is the core of the form. It presents a comprehensive list of potential financial wellness programs and allows the client to indicate their preferences.
Insights:
4. Program Preferences and Goals:
Purpose: This section focuses on the client's overall objectives for implementing a financial wellness program.
Insights:
5. Additional Information:
Purpose: This section provides an open-ended opportunity for the client to share any other relevant information.
Insights:
Overall Effectiveness:
Potential Improvements:
By implementing this detailed intake form, you can effectively gather the necessary information to create a successful and impactful financial wellness program for your clients.