Company Name
Contact Person
Job Title
Email Address
Phone Number
Company Size
Industry
Location(s) of Operations
City
State
Zip Code
Please indicate your level of interest in the following financial wellness programs (1 = Not Interested, 5 = Very Interested):
Program | Rating (1 = Not Interested, 5 = Very Interested) | ||
|---|---|---|---|
1 | Budgeting and Financial Literacy Workshops | ||
2 | Debt Management and Reduction Strategies | ||
3 | Retirement Planning and Savings Programs | ||
4 | Investment Education and Guidance | ||
5 | Tax Planning and Optimization | ||
6 | Emergency Savings and Financial Safety Nets | ||
7 | Student Loan Repayment Assistance Programs | ||
8 | Homeownership and Mortgage Planning | ||
9 | Insurance Planning (Life, Health, Disability) | ||
10 | Estate Planning and Wealth Transfer Strategies | ||
11 | Financial Coaching and One-on-One Counseling | ||
12 | Employee Discount Programs (e.g., gym, retail) | ||
13 | Financial Wellness Apps and Tools |
What percentage (%) of your employees are:
Under 30:
30–50:
Over 50:
What are the most common financial challenges your employees face?
Managing debt
Saving for retirement
Budgeting and cash flow management
Understanding investments
Planning for major life events (e.g., home purchase, education)
Other:
How do employees currently access financial wellness resources?
Not offered
Internal HR resources
External financial advisors
Online tools and apps
Other:
Preferred Format for Financial Wellness Programs:
In-person workshops
Virtual webinars
On-demand videos
Printed materials
Mobile apps
Other:
Preferred Frequency of Programs:
Quarterly
Bi-annually
Annually
As needed
Other:
Preferred Time for Programs:
During work hours
After work hours
Lunch-and-learn sessions
Flexible timing (employee choice)
Other:
What is your budget for financial wellness programs?
Under $5,000.00
$5,000.00–$10,000.00
$10,000.00–$25,000.00
Over $50,000.00
Other:
Do you have internal resources to support program implementation?
Are you open to partnering with external financial wellness providers?
Yes
No
Maybe
What are your primary goals for implementing a financial wellness program?
Improve employee financial literacy
Reduce employee financial stress
Increase retirement savings participation
Enhance employee retention and satisfaction
Boost productivity and morale
Other:
How will you measure the success of the program?
Employee feedback surveys
Participation rates
Improvement in financial behaviors (e.g., savings rates, debt reduction)
Retention and turnover rates
Other:
Are there any specific financial wellness topics or concerns you would like addressed?
Do you have any existing wellness programs?
Any other comments or requests?
By submitting this form, you authorize us to use the provided information to design and propose a tailored financial wellness program for your organization.
Signature:
Form Template Insight
Please remove this form template insight section before publishing.
The Corporate Wellness Programs: Financial Planning Assistance Client Intake Form is a comprehensive tool designed to gather critical information about a company’s needs, preferences, and goals for implementing financial wellness programs. Below is a detailed breakdown of the form’s sections, their purpose, and the insights they provide:
1. Client Information
This section collects basic details about the company and its primary contact person.
Purpose: To identify the client and establish communication channels.
Insights:
2. Program Preferences
This section uses a rating system to gauge the client’s interest in various financial wellness programs.
Purpose: To understand which programs align with the client’s priorities.
Insights:
3. Employee Demographics and Needs
This section focuses on the workforce’s characteristics and financial challenges.
Purpose: To tailor programs to the specific needs of employees.
Insights:
4. Program Delivery Preferences
This section explores how the client prefers to deliver financial wellness programs.
Purpose: To ensure the program format aligns with the company’s operational structure and employee preferences.
Insights:
5. Budget and Resources
This section assesses the client’s financial commitment and available resources.
Purpose: To design a program that fits within the client’s budget and resource constraints.
Insights:
6. Goals and Success Metrics
This section identifies the client’s objectives and how they plan to measure success.
Purpose: To align the program with the client’s desired outcomes.
Insights:
7. Additional Information
This section allows the client to provide any extra details or requests.
Purpose: To capture unique needs or concerns not covered in previous sections.
Insights:
8. Authorization and Submission
This section formalizes the client’s consent to use the provided information.
Purpose: To ensure compliance and establish a formal agreement.
Insights:
Key Insights from the Form
How to Use the Insights
This form is a powerful tool for designing effective, tailored financial wellness programs that meet the unique needs of each client and their employees.