Client Feedback Form
The purpose of this survey is to ensure that our files are up-to-date, that our clients are receiving the level of service they deserve and to enable us to provide new services and appreciation events that you will enjoy.

Please feel free to add any further information that you think would be of value to us in the additional comments section at the end of the questionnaire. Thank you.

Note, required fields are marked with a *.
*Current Address:
*Contact Phone Number:
Primary Beneficiary(ies):
Do you have a Power of Attorney? Name:
Yes No
Do you have a valid Will? Last Updated:
Yes No
Do you have an accountant? Name:
Yes No
Do you have a lawyer? Name:
Yes No
Do you have a mortgage? Where:
Yes No

Will your estate include charitable bequests? Yes No

What do you value most about your relationship with Brown Financial & Insurance Services?

What percentage of your insurance and investment needs are managed by the following:

%  Brown Financial Provide details for Bank/Advisor/Other below:
%  Bank
%  Advisor
%  Other

Would you like Brown Financial & Insurance Services to provide you with a comprehensive review of your investment portfolio? Yes No

The following are the elements considered to be most important in a relationship with a financial advisor. Please rank the following in order of importance to you (1 = most important, 8 = least important).

Good Advise
Trust and Ethics

How often do you like to be contacted?

Monthly Semi-Annually
Quarterly Annually
Don't call me, I'll call you Never

What form of communication do you prefer for purposes other than review of your portfolio?

Telephone Face-to-face
E-mail => address:

What other forms of communication would you like to receive? (Please select all that apply.)
Direct mail Small workshop
Large seminars Telephone calls
Personal newsletter Other:

Which of these lifestyle changes do you expect over the next twelve to eighteen months? (Please select all that apply.)
Graduate Start a business Start a financial plan
Marry Receive an inheritance Invest more money
Buy a home Borrow money Sell property
Have a child Pay off a loan Sell a business
Change employment Save more money Retire
Receive a promotion Purchase property Other:

What hobbies or special interests do you have? (Please select all that apply.)
Travel Interior Design & Renovating Wine making & Tasting
Golf Home entertainment & Cooking Gardening & Landscaping
Internet Antique collecting & Refinishing Hiking & Mountain biking
Art & Music Bird watching & Photography Other:

Which of these topics do you feel are priorities to you? (Please select all that apply.)
Personal/Spousal life insurance Charitable giving
Review existing coverages Non-RRSP investing strategies
Mortgage life/disability insurance Personal estate organization
Disability income protection Planning for retirement
Long-term care insurance Business insurance planning
Retirement saving Business succession planning
Education plans Employee Benefits
Estate planning Other:

Brown Financial should contact the following people regarding financial/insurance matters:

Additional Comments:

*Once we have received your completed survey would you like us to contact you to discuss your responses?
Yes No

Thank you again for taking the time to complete this survey. We will inform you of some of the common responses in a letter to follow in the coming months.

Please be sure to provide all mandatory information (marked by *) in this form prior to submitting. If you submit an incomplete form and your browser cache settings are not correct you may return to a blank form.