Exploration Intake Form

Tell us about yourself

This takes less than five minutes. Only your name and email are required. Everything else helps the first conversation start further along, so fill in what you feel is important and what you are comfortable sharing. Everything you do share is encrypted, stored securely, and never sold or shared with anyone outside my firm.

About

First name RequiredMiddle nameLast name Required

Marital statusDate of birth

Work

Job titleCompany

Contact

Email RequiredEmail type

PhonePhone type

Street addressApartment or unit

CityStateZIPAddress type

Online

WebsiteLinkedInX handle

BackgroundWhat's on your mindPlease share a little about your current situation like your goals, your finances, what keeps you up at night, and anything you feel can provide value to our call. Please do not include account numbers, Social Security numbers, or other sensitive identifiers.

Your finances

Investment and retirement accountsA rough estimate across 401(k)s, IRAs, and brokerage accounts. We are not asking for exact figures or account numbers.Annual household incomeBefore taxes, including salary, business income, and distributions.

Your information goes directly into our client records and is not shared with anyone outside the firm. Modern Wealth does not provide legal or tax advice and does not draft documents.

Thank you for submitting the Exploration intake form.