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 ("Form CRS").

Note: For your privacy and protection, all submitted data uses HTTPS encryption and is deleted automatically as soon as it's entered into our Customer Relationship Management (CRM) system. If you have any questions or concerns with submitting your personal information, please contact your Advisor or click here to review our Disclaimers and Privacy Policy.

Step 1 of 4

Contact Information
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Account ID

Placeholder for the Unique Account ID Primary Key
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Advisor User ID
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Advisor's Name
First Last
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Advisor Email

Hidden placeholder for the email of the account's assigned advisor
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CSM User ID

Whoever clicks on the 'Send Fact Finder' button in SF will have their SF User ID populated here.
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CSM's Name
First Last
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CSM Email

This field will lookup the email of whoever clicked on the SF Send Fact Finder button for notification purposes.
Salutation*
Full Legal Name*
First Middle Last
Nickname
If applicable, enter your nickname.
Maiden Name
If applicable, enter your maiden last name.
Mobile Phone*
Email*
Enter Email Confirm Email
Contact Preference*
Preferred Contact Time*
Mailing Address*
Street Address City State ZIP Code
Is the Mailing Address and Physical Address the same?*
Physical Address*
Street Address 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
MM slash DD slash YYYY
Country of Birth*
Please select your country of birth.
U.S. State of Birth*
Please select the state abbreviation for the state you were born in.
Social Security Number / Tax ID

Please enter your SSN or Tax ID using the appropriate format (i.e., XXX-XX-XXXX).
Physical ID Type
Please select a physical ID type (Driver's License, Passport, or Visa).
Driver's License Number
Issuing State of Driver's License
Driver's License Issue Date
MM slash DD slash YYYY
Driver's License Expiration Date
MM slash DD slash YYYY
Passport Number
Passport Issuer
Passport Issue Date
MM slash DD slash YYYY
Passport Expiration Date
MM slash DD slash YYYY
Visa Number
Visa Type
Visa Country of Origin
Visa Date Obtained
MM slash DD slash YYYY
Visa Expiration Date
MM slash DD slash YYYY
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 a number greater than or equal to 0.
Please enter the number of dependents you have. If zero, enter 0.
Full Legal Name and Date of Birth of Dependent(s):
Please enter the full legal name and date of birth of your dependent(s). Separate each dependent with a semicolon. For example: Josh Lee Porter, 3/27/2013; James Byron Porter, 9/14/2018.
Industry*
If your industry is in the medical field, select 'Healthcare.' If your industry is not listed, 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?*

Step 1 of 4

Contact Information

Personal Information

Affiliations

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