Client Pre-Screening
Let's Build Your Protection Plan
Answer a few quick questions so we can prepare the most relevant strategy for your family, your income, and your future. No commitment — just clarity.
Question 1
What's your first name?
Please enter your first name to continue.
Press Enter ↵
Question 2
And your last name?
Please enter your last name to continue.
Press Enter ↵
Question 3
What's your email address?
We'll send your personalized strategy summary here.
Please enter a valid email address.
Press Enter ↵
Question 4
Best phone number to reach you?
We'll only call or WhatsApp to confirm your discovery call — no spam, ever.
Please enter a valid phone number.
Press Enter ↵
Question 5
What state do you currently reside in?
This confirms we can serve you in your area.
▾
Please select your state to continue.
Press Enter ↵
Question 6
What is your age range?
Please select an option to continue.
Question 7
Are you the primary income earner in your household?
Please select an option to continue.
Question 8
Which best describes your family situation?
Please select an option to continue.
Question 9
What brings you here today?
Select all that apply
Please select at least one option.
Question 10
Do you currently have life insurance?
Please select an option to continue.
Question 11
What is your approximate annual household income?
This helps us recommend the right protection tier for your family.
Please select an option to continue.
Question 12
What monthly budget feels comfortable for your protection plan?
There's no wrong answer — we tailor solutions to every budget.
Please select an option to continue.
Question 13
How would you describe your overall health?
Carriers consider health in underwriting — this helps us identify the best-fit options for you.
Please select an option to continue.
Question 14
Do you use any tobacco or nicotine products?
This affects your rate class more than almost any other factor — carriers price non-smokers and smokers very differently.
Please select an option to continue.
Question 15
Are you affiliated with the military or government service?
We offer specialized planning for service members and government employees.
Please select an option to continue.
Are you currently stationed or living outside the United States?
Please indicate your current location to continue.
Question 16
How did you hear about Ayonic Wealth Protection?
Please select an option to continue.
Final Question
Anything else you'd like us to know before your call?
Optional — share any context, concerns, or questions you have in mind.
Press Enter ↵ to submit
You're all set!
Your responses have been received — thank you for sharing your goals.
Pick a date and time below to lock in your complimentary 30-minute Strategy Call. We look forward to connecting with you.
