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Fa De Kulcha Intake Form

Welcome to your Financial Coaching Intake Form!

This form helps us better understand your current financial habits, challenges, and goals so we can create a personalized plan tailored to your needs. Whether you’re working on improving money management, building consistent saving habits, creating an emergency fund, or strengthening your overall financial foundation, your responses will help us provide the best possible support and guidance.

Please answer each question honestly — there are no right or wrong answers. All information shared is kept strictly confidential and used solely to support your financial growth and coaching experience.

We’re excited to support you on your journey toward greater financial confidence, stability, and freedom.

Section 1: Client Information

Preferred Contact Method
Email
Phone
WhatsApp
Age Range

Section 2: Financial Snapshot

What are your current sources of income?
Approximate monthly take-home income:
Approximate monthly expenses:
Do you currently have any debt?
No
Yes - Under $5,000
$5,000-$15,000
$15,000+

Section 3: Goals & Priorities

How urgent are these goals?
Very urgent
Somewhat urgent
Not urgent

Section 4: Habits & Financial Experience

How would you describe your current financial habits?
Very organised
Mostly organised
Somewhat organised
Not Organised
I'm starting from scratch
How comfortable are you with budgeting?
Very confident
Somewhat confident
Not confident
I've never budgeted before
How consistent are you with saving money?
Very confident
Somewhat confident
Not confident
I've never invested before
Do you currently have an emergency fund?
Yes, fully funded
Yes, but I'm still building it
No, but I want to start one
No, and I'm not sure where to begin
What area of your finances do you feel you need the most support with?
How often do financial stress or money concerns affect your daily life?
Very often
Sometimes
Rarely
Almost never

Examples:

  • Build consistent savings

  • Stop living paycheck to paycheck

  • Create an emergency fund

  • Improve spending habits

  • Feel more financially organized

Section 5: Service interest & Final Notes

Which package are you most interested in?
Financial Foundations Consultation
Savings Kickstart
Financial Growth Plan
Financial Growth Plan Extended
Financial Freedom Blueprint
Not sure yet — please recommend the best fit
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