Post-Consultation questionnaire

1 Client Information

Client Name

Date of Consultation

ZIP Code

Email Address

2 Household Profile

Number of Adults

Number of Children

Seniors (65+) in household?

House staff or caregivers?

Primary language spoken at home

Pets in household?

Disabilities or functional needs in household?

Medical equipment required?

Yes No

Mobility assistance required?

Yes No

Daily medication required?

Yes No

3 Property & Infrastructure

Property type

Garage?

Backup power

Whole-house generator Portable generator Battery system Small battery packs None

Knows how to shut off utilities?

Gas Water Electricity None

Fire extinguishers on each floor and in garage?

Yes No

4 Evacuation Planning

Written evacuation plan?

Yes No

Family meeting point outside neighborhood?

Yes No

Out-of-area contact established?

Yes No

Multiple evacuation routes identified?

Yes No

Vehicle fuel habit

Always keeps ½ tank+ Usually Rarely / No

Evacuation plan for pets?

Yes No No pets

5 Emergency Supplies

Go-bags prepared for each member?

Yes Partially No

Go-bags up-to-date?

Yes No

Days household can sustain itself independently

Emergency supplies in vehicles?

Yes No

Backup lighting?

Yes No

Battery-operated radio?

Yes No

6 Insurance & Asset Documentation

Documented home inventory?

Yes Partial None

Photo / video documentation of assets?

Yes Partial None

Inventory includes receipts / appraisals?

Yes Partial None

Appraisals up-to-date (under 2 years)?

Yes Partial None

Where do receipts and appraisals currently live?

Printed, one place One email account Multiple email accounts Accounting system Scattered

Documents digitized and cloud-backed?

Yes Partial None

Physical copies in fireproof safe?

Yes No

7 Risk Awareness & Priorities

Primary concerns about disaster preparedness

Evacuation logistics Insurance documentation Power outages Family safety Property protection

What motivated them to explore resilience planning?

Insurance concerns Recent wildfire Family safety Property protection Peace of mind

Advisor notes (internal only)

Advisor Portal

Private Household Risk Assessment

Visit Materials

Past Consultations

Held Advisory Group