BURKETT FINANCIAL SERVICES, LLC
Registered Investment Advisors 

 Financial Life Checkup

So we can better serve you, please fill out and submit the form below.

First Name:  
Last Name:  
Business:  
eMail Address:  
Phone Number:  
ability to meet obligations: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
spending habits: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
level of my debt: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
my current income potential: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
the extras I can afford: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
my insurance quality and level: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
investment choices: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
amount I save and invest: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
retirement nest egg: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
my current employee benefits: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
my style of bookkeeping: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
my estate plan: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
my level of charitable giving: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
plans for children's education: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
level of my finance education: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
emotional response to finance: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
communication about my money: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
feelings about my money: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
my relationships and my money: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied
working relationships with CPAs: Very Satisfied Somewhat Satisfied No Opinion Somewhat Dissatisfied Very Dissatisfied