Strategic Edge

Please use the following confidential information to provide my analysis, without cost or obligation.
You can either send this form online through Email or Print & Fax facility.

Dr:		DOB:
Spouse:		DOB:
Spouse Occupation:
Anticipated years to retirement:
Annual net revenue of practice: (Earnings after expenses but before tax)	$ K
Current personal monthly expenses:	$ K (Aftertax)
Anticipated expenses in retirement:	$ K (Aftertax)

Best way to reach me is:

(email address or best contact number)

Best day/time to call is:

Please contact my accountant directly:

Name:

Phone:

Best day(s) for appointments are:

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