Intake Form – Individuals If you are a business, please click here for the business intake form If you are looking for the GENERAL CONTACT form, please click here Intake Form for Individuals – Let’s Get Started! Thank you for your interest in Clark and Cassidy. The first step to getting on our calendar is to thoughtfully complete the following questionnaire. It will help us determine if we will be a good fit and how we can best serve your needs. Name* First Last Email* Mobile Phone*We use an SMS texting service to stay in close communication with our clients, so it is important for us to have your mobile phone number.Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about Clark and Cassidy? About YouWhy are you looking to make a change or seeking the services of our firm?* Are you self employed?* Yes No Do you have rental properties?* Yes No Do you have investments in more than one state?* Yes No What was the total income reported on your tax return last year? What was the federal taxable income reported on your tax return last year? What is the #1 challenge you are dealing with today, that if we solved together, would create the biggest impact in your finances?What are your expectations of our firm?On a scale of 1 – 10 (10 being highest), how urgently important is it for you to get started, and why?* 1 No urgency 2 3 4 5 6 7 8 9 10 Extremely urgent Can you briefly tell us why? CAPTCHACommentsThis field is for validation purposes and should be left unchanged.