Capellis Financials — Client Intake Form

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Basic Client Information

Let's start with the essentials. All fields marked with ✦ are required.

Personal Details

Full Name ✦

Email Address ✦

Phone Number

Preferred Contact Method

Age Range (optional)

Household Size

Employment Status ✦

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Services Requested

Select all services you're interested in. This will customize the rest of your intake form to show only what's relevant.

What can we help you with?

📊 Transaction Categorization & Financial Statements

We merge and categorize your bank/card transactions into a clean monthly income & expense report

📋 Budget Creation

We build a personalized monthly budget based on your income and spending patterns

🤝 Budget Monitoring & Coaching

Ongoing accountability and coaching to help you stay on track month to month

💳 Debt Analysis & Payoff Planning

We analyze your debts and create a strategic payoff plan (avalanche, snowball, or custom)

🎓 General Financial Coaching

Personalized guidance on financial decision-making, habits, and goal-setting

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Income Overview

Help us understand your income sources. You don't need exact numbers — estimates are fine.

Primary Income

Income Source / Employer

Income Type

Pay Frequency

Average Monthly Take-Home

Income Stability

Stable / Consistent Somewhat Variable Highly Variable / Seasonal

Additional Income Sources (optional)

Source

Average Monthly Amount

Any other income sources?

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Financial Accounts

List the accounts you'd like included in your financial statements. Last 4 digits only — for reference purposes.

Bank Accounts

Institution Type Last 4 Digits

Credit Cards

Card / Issuer Network Last 4 Digits

Statement Access Method

I will upload statements (PDF or Excel)

You'll provide monthly statements directly — most common

Read-only account access

We can discuss a secure read-only connection if preferred

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Spending & Expenses

Give us context on your current spending habits. We'll fill in the details from your statements — this helps us set the right baseline.

Spending Context

What do you think you spend the most on?

Any irregular or seasonal expenses?

Do you currently track your spending?

Yes, consistently Sometimes No

Biggest spending challenges?

Monthly Expense Snapshot (estimates are fine)

Fixed Expenses

Rent / Mortgage

Utilities (avg)

Insurance (all)

Subscriptions & Services

Variable Expenses

Groceries

Dining Out & Delivery

Transportation

Entertainment

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Debt Details & Goals

Understanding your debt picture and what you're working toward helps us build the right plan.

Current Debts

Debt Type

Balance

Interest Rate

Min. Payment

Status

Creditor / Lender

Have you missed any payments in the last 6 months?

No Yes, 1–2 payments Yes, several

Primary debt goal

Lower my payments Pay it off faster Both

Financial Goals

Top 3 Financial Goals

Time Horizon

Biggest Financial Stressor Right Now

What would "success" look like in 6 months?

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Mindset & Preferences

These questions help us coach you in a way that actually fits your life — not just your numbers.

Financial Behavior

What has prevented you from sticking to a budget in the past?

How do you currently make spending decisions?

Comfort level discussing your finances (1 = very uncomfortable, 10 = totally open)

1

10

Biggest financial habit you want to change

Budgeting Preferences

Preferred budgeting style

Strict Categories

Every dollar has a specific bucket — maximum control

Flexible Spending

Loose guidelines with room to adjust — more realistic for most people

Zero-Based Budget

Every dollar is assigned — income minus all allocations equals zero

Not Sure — Help Me Decide

We'll recommend the best approach based on your situation

How often would you like to review your finances with us?

Weekly Bi-Weekly Monthly As Needed

Readiness Check

How urgent is your financial situation? (1 = not urgent, 10 = crisis mode)

1

10

Are you ready to make changes now?

Yes, I'm ready now Almost — need a little push Still exploring my options

How much time can you commit weekly to your finances?

Less than 30 min 30–60 minutes 1–2 hours Whatever it takes

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Documents & Consent

Upload any available documents and review the consent agreement below.

Document Upload (optional — you can provide these later)

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Bank Statements

Last 2–3 months · PDF or Excel

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Credit Card Statements

Last 2–3 months · PDF or Excel

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Loan Statements

Auto, personal, student loans

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Pay Stubs

Optional · Recent 1–2 stubs

Disclaimers & Consent

Not Legal, Tax, or Investment Advice. Capellis Financials provides personal finance organization, budgeting, and coaching services only. We are not licensed attorneys, CPAs, or investment advisors. Nothing in this engagement constitutes legal, tax, or investment advice. Please consult a licensed professional for those needs.

Data Privacy. All financial information you provide is kept strictly confidential and is used solely for the purpose of delivering the services you've requested. We do not sell, share, or disclose your data to third parties. Files are stored securely and deleted upon request.

Consent to Analyze Financial Data. By signing below, you authorize Capellis Financials to review, organize, and analyze the financial statements and information you provide for the purpose of creating financial reports, budgets, and coaching materials on your behalf.

I have read and agree to the disclaimers above ✦

I consent to Capellis Financials analyzing my financial data as described ✦

Electronic Signature ✦

Full Name (type to confirm)

Today's Date

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