Exploration Intake Form Five short steps, under five minutes. Only your name, email, and two quick ranges are required. Everything else helps our first conversation start further along, so share what you are comfortable sharing.
Start About you First name Required Middle name Last name Required
Marital status Prefer not to say Married Single Divorced Widowed Life Partner Separated Date of birth
How to reach you Email Required Email type Home Work Mobile Other
Phone Phone type Home Work Mobile Other
Street address Apartment or unit
City State ZIP Address type Home Work Mobile Other
Work and online Job title Company
Website LinkedIn X handle
What's on your mind What's on your mind Please 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 accounts Select a range Under $250,000 $250,000 to $500,000 $500,000 to $1 million $1 million to $2.5 million $2.5 million to $5 million Over $5 million Prefer to discuss on the call A rough estimate across 401(k)s, IRAs, and brokerage accounts. We are not asking for exact figures or account numbers. Annual household income Select a range Under $100,000 $100,000 to $250,000 $250,000 to $500,000 $500,000 to $1 million Over $1 million Prefer to discuss on the call Before taxes, including salary, business income, and distributions.
Company website
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.
