Client Name:_________________________________________

Appointment Checklist
TO ALLOW YOUR COUNSELOR TO PROVIDE A QUALITY SESSION, PLEASE BRING AS MANY RECENT STATEMENTS AS POSSIBLE.
1. Pay stubs for each source of income in the household			____________
2. Mortgage/Rent Payment Amount			____________
a. Association Fee Information, if applicable			____________
b. Property Tax and Insurance Information			____________
3. Utility Statements			____________
a. Heat/Gas			____________
b. Electric			____________
c. Water			____________
d. Telephone			____________
e. Cable			____________
f. Cellular Phone			____________
g. Pager			____________
h. Other			____________
4. Automobile Payment and Insurance Information			____________
5. Statements			____________
a. Credit Cards			____________
b. Medical/Dental Bills			____________
c. Book/Music Clubs			____________
d. Previous Years’ Income Tax Statements, if not paid.			____________
6. Loan Information			____________
a. Bank/Finance Company Loans			____________
b. Personal Loans			____________
c. Student Loans			____________
7. Other Applicable Items			____________
a. Threatening Notices			____________
b. Checkbook Register			____________
Home Budget Expenses:
Some of the items listed here may not apply. You may not know the exact amounts you spend every month on many of these items, but we would like an average. If you have been spending more on certain items than you feel is reasonable, please list the dollar amount you think would be reasonable to spend.
Groceries	____________	Dry Cleaning/Laundry		____________
Work Lunches	____________	Church/Charity		____________
School Lunches	____________	Tuition/Books		____________
Cigarettes/Tobacco	____________	Medical Care		____________
Gasoline	____________	Day Care		____________
Auto Insurance	____________	Child Support/Alimony		____________
Life Insurance	____________	Entertainment		____________
Medical Insurance	____________