Client Access
Menu
Home
About Us
Our Story
Who We Serve
Meet Our Team
Our Process
Insurance
Medicare
Life Insurance
Health Insurance
Disability Insurance
Long-Term Care
What We Charge
Resource Center
Retirement Calculator
Future Value Calculator
Blog
LPL Research
Fiduciary Focus
LPL by the Numbers
LPL by the Numbers
LPL Retirement Plan Tools
Disclosures
Useful Links
Contact Us
Client Access
Client Discovery Form
Welcome to Integrated Wealth.
This brief form helps us gather your information efficiently so we can serve you better. It should take about 5 minutes. If you’re unsure about any item or prefer not to answer, feel free to leave it blank — we can cover it together later.
First Name (Legal)
Nickname or Preferred Name
Middle Name
Last Name
Social Security Number
Date of Birth
Gender
Select
Female
Male
Marital Status
Select
Single
Married
Divorced
Widowed
Driver's License Number
Driver's License State
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Issue Date
Expiration Date
Email Address
Cell Phone Number
Home Phone
Home Address
City / State / ZIP
Mailing Address (if different)
Mailing City / State / ZIP
Primary Beneficiary
Contingent Beneficiaries (List all)
Occupation
Employer
Job Title
Annual Salary
Employer Address
City / State / ZIP
Have you worked with a financial advisor before?
Select
Yes
No
If yes, why are you exploring changing advisors?
Do you have an emergency fund?
Select
Yes
No
Do you own life insurance?
Select
Yes
No
Do you own disability insurance?
Select
Yes
No
Do you have a will/trust/POA?
Select
Yes
No
Experience with long-term care?
Select
Yes
No
Do you have a CPA/tax adviser?
Select
Yes
No
Are you saving for college?
Select
Yes
No
Not Applicable
Statement Preference
Select
Electronic
Physical
SmartVestor Clients Only: What Dave Ramsey Baby Step are you on?
Select
Baby Step 1: Save $1,000
Baby Step 2: Pay off all debt (except the house)
Baby Step 3: Save 3–6 months of expenses
Baby Step 4: Invest 15% in retirement
Baby Step 5: Save for children's college
Baby Step 6: Pay off your home early
Baby Step 7: Build wealth and give
Bank Name
Account Type (Ownership)
Select
Individual
Joint
Account Owner Name(s)
Routing Number
Account Number
Account Type (Checking/Savings)
Select
Checking
Savings
Submit
Thank you for your submission!
There was a problem with the form submission. Please try again.
