Client Onboarding Form

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Contact Information
Account ID
Unique Account ID for SF and Zapier integration
Joint or Individual?*
Please specify whether this account will be an individually-owned or jointly-owned. If it's a joint account, the co-owner will fill in their information on a separate page of this form.
Owner Name*
First Last
Owner Email*
Enter Email Confirm Email
Owner Phone*
Home / Physical Address
Street Address Address Line 2 City State ZIP Code
Is the Home / Physical Address and Mailing Address the same?*
Mailing Address*
Street Address Address Line 2 City State ZIP Code

Personal Information
SSN / Tax ID*
Date of Birth*
Gender*
U.S. Citizenship Status*
Driver's License Number*
State of Issued Driver's License*
Driver's License Expiration Date*
MM
DD
YYYY
Country of Birth
Country of Dual or Secondary Citizenship
If not applicable, select N/A.
Occupation
Employer
Work Location
Medical Specialty*
Owner's Annual Income

Co-Owner Contact Information
Co-Owner Name*
First Last
Co-Owner Email*
Enter Email Confirm Email
Co-Owner Phone*
Is the address information the same for both the Owner and Co-Owner?*
Co-Owner Home / Physical Address
Street Address Address Line 2 City State ZIP Code
Is the Co-Owner's Home / Physical Address and Mailing Address the same?*
Co-Owner Mailing Address*
Street Address Address Line 2 City State ZIP Code
Co-Owner Personal Information
Co-Owner SSN / Tax ID*
Co-Owner Date of Birth*
Co-Owner Gender*
Co-Owner U.S. Citizenship Status*
Co-Owner Driver's License Number*
State of Issued Driver's License*
Driver's License Expiration Date*
MM
DD
YYYY
Co-Owner's Country of Birth
Co-Owner's Country of Dual or Secondary Citizenship
If not applicable, select N/A.
Co-Owner's Occupation
If homemaker/retired/not employed, please select Not Employed.
Co-Owner's Employer
Co-Owner's Work Location
Co-Owner's Medical Specialty
Co-Owner's Annual Income
Leave blank if not employed or don't receive any income.

Affiliations (All Applicants)
Are you or the joint owner an employee of this firm?*
Are you or the joint owner related to an employee of this firm?*
Are you or the joint owner 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?*

Advisory Services Agreement
This Advisory Services Agreement (the “Agreement”) is made by and between Larson Financial Group, LLC (“LFG”), a registered investment adviser, whose mailing address is 14567 North Outer 40, Suite 300, Chesterfield, MO 63017, and the undersigned Client(s) (each a “Party” and collectively, the “Parties”).
1. SERVICES: LFG will provide Client(s) with the specific financial planning and/or advisory services designated below. The above identified Investment Adviser Representative (hereinafter, “IAR”) agrees to meet with Client for the purpose of acquiring information concerning Client’s assets, liabilities, present and anticipated obligations and present and future income and financial goals. The Parties acknowledge that IAR may be an independent contractor or employee, but is not an authorized principal of LFG. Client agrees to provide full and accurate information to their IAR. Within a reasonable time after receipt of the information, and in reliance upon the accuracy and completeness thereof, LFG, through the IAR, will furnish Client with a written financial plan addressing the following topics (select one):
Please Select a Service Option:*
- GOLD (May include the following: Cash Flow Analysis, Risk Management Strategy, Investment Analysis & Strategy, Retirement & Education Funding, Benefits Planning, Estate Planning*, Tax Strategy*)
- PLATINUM (Gold Services plus any of the following: In-depth Practice Analysis & Planning, Large Wealth Transfer Cases, Legacy & Multigenerational Planing, Real Estate Planning, Alternative Investment Analysis)
LFG and the IAR will perform the above-described Services as fiduciaries with respect to the Client(s), meaning that both are required to put the best interests of the Client(s) above their own and in connection with the Services provided. LFG and IAR agree to provide advisory services to Client(s) in a manner that is consistent with their fiduciary duties and applicable laws, courts, state and federal administrative bodies and regulatory authorities. Client acknowledges and understands that the financial plan that they receive may be composed of a number of collective items, including documents, spread- sheets, illustrations, communications, notes, and/or other forms containing information relevant to Client’s financial interests, including without limitation strategies, options, plans, and/or characteristics.

* LFG and IAR cannot provide tax or legal work or advice. Rather, as part of the client’s overall financial plan, a Client’s general tax considerations, and the Client’s current or intended estate plan, will be considered and analyzed. IAR will coordinate with other advisors as needed (attorney, CPA, etc.)
2. FEES: As compensation for rendering the Services described above, Client agrees to pay LFG the following fee, either as Services are rendered and a bill is received, or upon completion of the services and written financial plan and/or any other deliverables agreed upon. Clients that are residents or fellows are not billed until they have begun practicing. If Client terminates this Agreement within five business days of its effective date, Client will receive a full refund of any prepaid fee. If, at any time, Client determines that LFG has not provided financial value to client in the provision of its services, LFG will refund Client’s advisory service fees paid within the prior twelve (12) months.
Fees will be collected beginning:
Date Format: MM slash DD slash YYYY
Fees wil be payable through:*
Fee Collection Preference:*
Please Enter the Quarterly Fee Amount:*
Please Enter the Annual (Full Payment) Amount:*
If the above is not completed, Client will be invoiced beginning in LFG’s next billing cycle. Payment of an invoice from LFG is due within thirty (30) days of the date on such invoice. After one hundred and eighty (180) days, interest will accrue at a rate of ten percent (10%) annually until paid in full.
3. CLIENT'S RESPONSIBILITIES: During the course of this Agreement,Client will provide IAR with accurate and complete information about Client’s financial circumstances, financial goals and objectives, and risk tolerance, and will promptly inform IAR of any changes regarding such information. Client is responsible for the accuracy and completeness of all such information provided to IAR, and for any losses or damages attributable to Client’s failure to provide such information to IAR. LFG and IAR may act on instructions reasonably believed to be given by any Client who signs this Agreement, or someone authorized by a Client signing this Agreement, and Client agrees to hold LFG and IAR harmless for any losses or damages of any kind resulting from LFG or IAR following such instructions.

4. SCOPE OF ENGAGEMENT: To ensure that Client receives a suitable financial plan, LFG and IAR are required to obtain specific information relating to Client(s), including without limitation age, investments, financial information and needs, income and net worth, tax status, investment objectives, investment experience, investment time horizon, liquidity needs, and risk tolerance. Client acknowledges that LFG and IAR cannot adequately perform advisory services unless Client performs all responsibilities under this Agreement, including providing the above information, in a timely manner. LFG and IAR will not be required to verify any information provided by Client or any agent apparently acting on behalf of Client, and LFG and IAR are expressly authorized to rely on such information. Client’s attorneys, accountants, or other professionals are hereby authorized to provide LFG or IAR with Client’s information requested by LFG or IAR in the performance of this Agreement.

Client may accept or reject any recommendation from LFG or IAR, and Client acknowledges such discretion. The recommendations of IAR or LFG are based upon their professional judgment, and they do not guarantee the results of any recommendation. LFG and IAR cannot provide legal, accounting, tax, or brokerage services and Client is encouraged to separately engage the assistance of qualified professionals in the implementation of recommendations. Client retains sole discretion over all implementation decisions.

IRS Circular 230 Disclosure: To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. federal tax advice contained in this communication (including any attachments) is not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code or (ii) promoting, marketing or recommending to another party any transaction or matter addressed herein.

5. CONFIDENTIALITY: All information and advice furnished by either Party to the other hereunder, including their respective agents and employees, shall be treated as confidential and shall not be disclosed to third parties except as agreed upon in writing or required by law or the order of a regulatory body.

6. NON-EXCLUSIVITY, OTHER CLIENTS: Client understands and acknowledges that LFG and IAR provide advisory services to other clients, and that LFG and IAR may give advice, make recommendations, provide information and take action with respect to particular clients which may differ from advice, recommendations and information given or action taken under this Agreement.

7. STANDARD OF CARE: LFG and IAR will perform the advisory services in good faith and in accordance with applicable law. Federal and state securities laws impose liabilities under certain circumstances even upon persons who act in good faith. Except for gross negligence, willful malfeasance, or bad faith, LFG, the IAR, or their affiliates, members or employees will not be liable for any action performed or omitted, or any error in judgment made by them in carrying out the advisory services. Nothing in this Agreement constitutes a waiver of a Client’s legal rights under federal or state securities laws.

8. NO ASSIGNMENT: No Party may assign, convey, or otherwise transfer any of the rights, obligations or interests herein without the written consent of the other Party.

9. OTHER COMPENSATION: IAR is a registered representative of Larson Financial Securities, LLC, an affiliated, registered broker-dealer and FINRA and SIPC member. Larson Financial Group, LLC is also in a network of entities providing various separate and independent services (the “Doctors Only Network”). Client acknowledges that if Client chooses to effect investment recommendations through Larson Financial Securities, LLC, or engage other entities within the Doctors Only Network, Client’s IAR may receive other compensation therefrom.

10. TERM AND TERMINATION: This Agreement shall be effective for one calendar year from the date of Client’s signature below. This Agreement and the Fee provided herein above will automatically renew for successive one-year terms unless otherwise agreed by the Parties in writing, or if terminated as provided herein. Any Party may terminate this Agreement at any time by providing written notice to the other. The Parties agree that LFG may charge Client its reasonable costs that are attributable to the transfer of Client’s file(s) or other necessary or requested documents, data, or other property following termination of this Agreement.

11. RECEIPT OF DISCLOSURES: Client acknowledges receipt of LFG's most recent Customer Relationship Summary (“Form CRS”), Form ADV Part 2A ("Firm Brochure") and 2B Supplement, and LFG's Privacy Policy. While this Agreement is in effect, LFG will provide Client annually, without charge, an electronic copy of a summary of significant changes made to the Firm Brochure during the prior year, and/or an offer to provide a hard copy of the Firm Brochure upon Client's written request. Client may also obtain a copy of the Firm Brochure by going to https://www.adviserinfo.sec.gov/Firm/140599 or https://www.larsonfinancial.com/form-crs/

12. DEATH OR DISABILITY: Client’s executor, personal representative, attorney-in-fact, or other authorized representative may terminate this Agreement by written notice or continue this Agreement to the extent allowed by law or regulation, and in such event the respective rights of the Parties shall remain in full effect as otherwise provided.

13. DOCUMENTS AND FILES: Clients may receive written communications from LFG (“Client Communications”) via email or other electronic means without also receiving paper copies. By signing this Agreement, Client agrees to receive Client Communications (e.g., reports, notices, personal financial information) electronically in lieu of paper copies. While LFG may deliver paper copies of Client Communications from time to time, the delivery of such paper copies will not affect Client’s consent to future delivery of electronic Client Communications. This consent may be revoked at any time, and Client may elect to receive paper copies by informing LFG of this change in writing. Furthermore, Client acknowledges that it is Client’s responsibility to immediately review Client Communications delivered to the email or mailing address(es) provided to LFG.” Client further agrees to contact LFG should there be a discrepancy as to the contents therein. Client may incur costs such as Internet Access fees and other online charges by agreeing to receive Client Communications electronically. Client agrees to hold LFG and its affiliates, officers, members, managers, employees, agents, successors and assigns harmless and free from any damages related to or arising from the delivery of Client Communications via e-mail. LFG does not maintain custodial responsibility for any records or documents other than advisory or securities-related materials, which LFG will maintain pursuant to applicable industry rules and regulations.

14. ARBITRATION: If a dispute arises out of this Agreement and cannot be settled through informal negotiation, the Parties agree that the exclusive procedure for resolving such dispute shall be by arbitration, administered by the American Arbitration Association (AAA), pursuant to the Rules of Commercial Arbitration and Mediation Center for the Americas (CAMCA) in effect at the time such action is taken. The Arbitration itself shall take place in the County of St. Louis, State of Missouri, at a location mutually agreed between the Parties. If the Parties cannot agree, a location in the County of St. Louis, State of Missouri shall be chosen pursuant to the CAMCA rules then in effect. The Parties agree that the arbitrator(s)’ or arbitration panel’s decision will be final and binding. The arbitrator(s) will be chosen in accordance with the CAMCA rules then in effect. This agreement to arbitrate does not constitute a waiver of any rights guaranteed under state or federal securities laws.

15. GOVERNING LAW: This Agreement will be deemed accepted in Missouri. To the extent not inconsistent with federal law, this Agreement and any dispute, disagreement, or issue of construction or interpretation arising hereunder whether relating to its execution, validity, obligations hereunder, or performance shall be governed and construed in accordance with Missouri state law, or federal statute where applicable.

16. ALTERNATIVE FORUM: In the event that AAA declines to accept a claim arising from or relating to this Agreement, or a court of competent jurisdiction strikes the arbitration provisions hereof or holds those provisions to be unenforceable for any reason, and in only such an event, then the exclusive jurisdiction and venue for any court proceedings arising out of or related to this Agreement will be in the state courts of St. Louis County, Missouri or the U.S. District Court for the Eastern District of Missouri. The Parties hereby submit to the jurisdiction of such courts and agree to forever waive any objection to the exclusive jurisdiction and venue agreed herein.

17. DEPARTURE OF IAR: Client and LFG acknowledge Client’s right to choose its IAR. In the event that the IAR named above concludes its professional association with LFG, this Agreement will be in full force and effect unless and until Client or LFG Terminate the Agreement as provided herein above. Any inquiries or instructions relating to a Client’s choice of IAR or Termination of this Agreement should be directed to: Larson Financial Group, LLC Compliance Department, compliancedepartment@larsonfinancial.com or by phone: 314.438.2083.

18. SEVERABILITY: If any provision of this Agreement shall be found to be unenforceable by a court or arbitrator of proper jurisdiction, then it shall be deemed severable from and will in no way affect the enforceability of, the remaining provisions of this Agreement.

19. OTHER PROVISIONS: Nothing in this Agreement grants discretionary power over Client’s assets or accounts to LFG or the IAR. This is the entire agreement of the Parties and supersedes any prior understandings, terms, or other agreements. This Agreement cannot be modified or amended except by a written instrument signed by all Parties. LFG reserves the right to refuse this Agreement in its sole discretion and for any reason. In general, LFG does not acquire or exercise proxy voting on Clients’ behalf in connection with our advisory services. Client(s) may receive proxy materials from issuers of funds or individual securities and/or their service providers. LFG will not advise Clients on such voting of proxies.
THIS CONTRACT CONTAINS A BINDING ARBITRATION PROVISION WHICH MAY BE ENFORCED BY THE PARTIES

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.

By signing below, I represent that the information on this form is accurate and that I will notify you in writing immediately if any change is required to the information. I have received, read and understand, and agree to abide by all the terms and conditions of the Customer Relationship Summary, the Disclaimers and Privacy Policy Statement as well as this advisory services agreement which have been provided to me by Larson Financial Group. I consent to electronic document delivery and agree that the electronic signature(s) appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
Owner Signature*
Date*
Co-Owner Signature*
Date*

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

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Contact Information

Personal Information

Co-Owner Contact Information

Co-Owner Personal Information

Affiliations (All Applicants)

Advisory Services Agreement

THIS CONTRACT CONTAINS A BINDING ARBITRATION PROVISION WHICH MAY BE ENFORCED BY THE PARTIES

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