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Your Needs Assessment Tool

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 Your family. Your health. Your home. Your business. Each an important element of your life, which changes at a rapid pace. Are you able to ensure the security of each? Do you have plans in place to help safeguard yourself and your loved ones should your financial security be threatened? Are you and your family adequately insured? The proper coverage can provide you with protection, peace of mind, and a plan for the future.

Please answer the following questions to help us provide suggestions for consideration regarding your insurance needs.

1. What is your age?

2. Life Events

Check all that apply.

a. Personal Events

Getting married
Have a mortgage/new home
Have child(ren)/new baby
Caring for aging parent(s)
Sending child(ren) to college
Other

b. Career Events

Nearing retirement
Changing firms/opening a law office
Making partner
Other

3. What is the size of your firm?

1-5
6-20
21 or more

4. Indicate your current coverage:
a. Term Life Insurance (total):
b. Monthly Disability Benefits:
5. What is your current income?
Current income:

This information will be used in the subsequent pages to provide you direction on your insurance needs and is not stored and is strictly confidential.

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