Rewired Intake – Dr Rouse Now

Let's do the basic contact info first; What's your...

First Name

Last Name

Best Email Address so we can get your Cash Flow Plan to you:

Mobile (in case we have any additional questions or need clarification on your answers)

So we have a starting point for you, What is your current age?

So we can model your plan accurately, what is your approximate annual income from all current sources not counting Social Security payments, if any? (Ballpark estimate is perfectly fine.)

About how much do you currently have saved for retirement? (IRAs, Roth, 401(k), brokerage — an estimate is all we need.)

Do you know your approximate Social Security benefit amount — either current or projected? (Best estimate is fine.)

Now What are your goals? Money First: What is Your monthly cash-flow target? How much money do you need on top of whatever pension, annuity, and or Social Security payments you'll receive. eg: $3,000, $5.000, $7,000, $12,000/month. What's your number to keep the lifestyle you want? Keep it real. This is NOT some get rich quick thing. What do you need to make you comfortable without money worries each month.

Now, How soon would you realistically like to reach it?

12 Months

24 Months

36 Months

More than 36 Months. I'm flexible.

How much time (minutes/day) can you commit (after market hours) to reach it?

10-15

20 (ideal)

25-30

Now, What's your starting point (so we model it right)? How much money can you commit to your achieving your goal?

$3,000–$4,999

$5,000–$7,499 (recommended minimum)

$7,500–$10,000

$10,000 + (recommended maximum $10K)

Are you comfortable with the “no new money” rule (grow only from profits after initial starting funds) ?

Yes, that works for me

I’m unsure (explain in notes)

Explain

How would you describe your personal comfort level with investment risk? Please select the option that best reflects your current approach to managing your money and investments.

What's Experience with markets?

None / New to this

Some experience (ETFs, mutual funds)

Have used charting/screeners

Other, Describe

Describe other market experience:

Regarding the possible Tax Free option, Do you have (or plan to use) a self-directed Roth account? “This lets profits accrue tax-free. Your plan will show both with/without-Roth scenarios.

Yes

Not yet, but open to it

No / Not applicable; Not a concern

Is a spouse/partner involved in this decision?

Yes, include them

No/ Not needed

Maybe later

If Yes, What's their name?

First Name

Last Name

If Yes, What's their email

What’s your biggest concern right now?

Outliving my savings

Losing the starting stake

Time/discipline to follow the routine

Spousal skepticism

Internet “scam” fatigue

Other concerns, list below

If you have additional or other concerns explain here...

I Acknowledge...

I understand this plan is educational and not individualized financial advice.

I understand projections are illustrative and depend on disciplined execution.

I consent to receive my plan and related communications via email/SMS.

Optional next step...

If my plan looks good, I’d like details on the mentorship to execute it safely.