Financial Concerns Worksheet

Please fill out the form below to the full extent of your abilities. The more information we obtain from you, the more we will be able to help going forward!

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1. At what age do you want to retire?

2. Will you have enough money to be able to retire when you factor in inflation and rising costs? 

3. What kind of retirement do you envision having? 

Pre-mature Death:

1. Will your family be able to maintain the same standard of living? 

2. Do you have a will or a trust in place?

Long Term Illness:

1. How will you pay the bills? Do you have an emergency fund? 


1. Who will take care of you or the people you take care of now?  

Key employee or Stockholder Death:

1. How will you fill the void (liquidation, consolidation, increased debt load)? 

Financial Advisory Team:

1. How happy are you with your accountant, attorney, insurance agent, realtor, etc.? 

Macro-Economic/Political Direction:

1. Inflation

2. Taxes

3. Future Income

4. Healthcare

5. Environment/Pollution

6. Public Morals




1840 5th St. Springfield, OR 97477  |  (O) 541-583-0093  |

Investment advice is offered through Belpointe Asset Management, LLC. Insurance and annuity products may be offered through D.H. Hill Securities, LLLP. Securities are offered through D.H. Hill Securities, LLLP, Member FINRA/SIPC. D.H. Hill Securities, LLLP, Todd Mann Financial Services Inc., and Belpointe Asset Management, LLC are not affiliated entities. Todd Mann Financial Services Inc. is currently insurance licensed in the states of Oregon, New Jersey, and Wisconsin.

Insurance and annuity products may be offered through D.H. Hill Securities, LLLP. 


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