Client Fact Finding Form

Please complete this form so we can get to know you better and to begin your services with Larson Financial Group. Additionally, during our meetings, we may give you a variety of recommendations regarding topics such as financial planning, investment strategies, wealth management, etc. When making these types of recommendations, we want to make sure you understand our relationship to you as our client. Please Click Here to Review Our Customer Relationship Summary.

Contact Information
Account ID
Placeholder for the Unique Account ID Primary Key
Advisor Email

Hidden placeholder for the email of the account's assigned advisor
Your Advisor's Name
Salutation*
Full Legal Name*
First Middle Last
Nickname
If applicable, enter your nickname. Otherwise, leave the field blank.
Maiden Name
If applicable, enter your maiden last name. Otherwise, leave the field blank.
Mobile Phone*
Email*
Enter Email Confirm Email
Contact Preference*
Preferred Contact Time*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Is the Mailing Address and Physical Address the same?*
Physical Address*
Street Address Address Line 2 City State ZIP Code
How Did You Hear About Us?
Select 'Other' if you heard about us from something not included in this list.
Enter the Name of the Client Who Referred You
First Last
Please Specify How You Heard About Us:

Personal Information
Date of Birth*
State of Birth*
Please select the state abbreviation for the state you were born in. If you were not born in the U.S., please select 'n/a'.
Gender*
Marital Status*
Spouse's Full Legal Name*
First Middle Last
Please enter your spouse's full legal name.
Spouse's Email
Enter Email Confirm Email
Number of Dependents*
Please enter the number of dependents you have. If zero, enter 0.
Full Legal Name and Age of Dependent(s):
Please enter the full legal names and ages of your dependent(s). Separate each dependent with a semicolon. For example: Josh Lee Porter, 7; James Byron Porter, 4.
Industry*
If your industry is in the medical field, select 'Healthcare'. If your industry is not listed, or if you're a homemaker / retired / not employed, please select 'Other'.
Current Employer
Please enter the name of your current employer. If you're a homemaker / retired / not employed, leave this field blank.
Medical Specialty
Please select your medical specialty. If it's not applicable, select 'N/A'. If your medical specialty is not listed, select 'Other'.
Medical Subspecialty
Please select your medical subspecialty. If it's not applicable, select 'N/A'. If your medical subspecialty is not listed, select 'Other'.
Doctor Type
Please select where you are in your medical training / practice. If none of the options best describe you, select 'Other.'
Year Entered / Entering Practice (YYYY)
Please enter the year you entered practice or expect to enter your practice (i.e., 2009, 2023, etc.)
Estimated Annual Income*
If you're a homemaker / retired / not employed and/or don't receive any annual income, enter zero.

Affiliations
Are you an employee of this firm?*
Are you related to an employee of this firm?*
Are you an officer or large shareholder of a public corporation?*
Is any member of your immediate family affiliated with a member of FINRA or the stock exchange?*

An important message from Larson Financial Group regarding COVID-19.

Step 1 of 4

Contact Information

Personal Information

Affiliations

What Types of Services Are You Interested In?

Submit Your Documents

LFG Newsletter for Doctors

The Physician’s Specialist®

Quick Links