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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
Phone Number
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Please enter a valid phone number.
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4
What best describes you?
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Choose all that apply
I'm currently a Travel Nurse
I'm about to start my first assignment
I'm a Travel Healthcare Professional but not a Nurse
I'm a Staff Nurse
Other
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5
What best describes your current situation?
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I need help setting Financial Priorities and Goals
I need help with Tax Management (*Please note that we only provide tax services to ongoing clients - no tax-only service)
I need help with planning my Retirement
I need help with growing my Investments
I need help with saving For Major Purchases
I need help with my Disorganized Finances
I need help with Managing my Debt
I need help with combining Old 401ks/403bs
I need help getting appropriate Insurance Coverage
Other
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6
Age
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7
Marital Status
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Single
Married
Long-term Partner
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Please Select
Single
Married
Long-term Partner
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8
After paying my monthly expenses, I could comfortably save $1,500 per month to invest for retirement and my other goals.
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YES
NO
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9
My annual Taxable and Stipend income is...
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Enter your estimated annual taxable income
Enter your estimated annual tax-free stipend income
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10
Please Review our Fees
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11
If you agree that we can help you in a meaningful way, will your budget allow you to pay our stated fees above?
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*Please note that we only provide tax services to ongoing clients - no tax-only service
YES
NO
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12
Where did you hear about us?
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Choose all that apply
Travel Nurse Webinar
Instagram
Facebook
Firm Website
The Gypsy Nurse
Other Nurse Referral
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