Client needs analysis worksheet

Life and Health Insurance Agent or Agency | PublicProof Academy working document

Non-editable educational sample of record categories. Not an approved clinical form or treatment protocol. A qualified professional must review suitability before use in their own secure system.

Business

State or jurisdiction

Prepared on

Owner

Official source saved

Next review

Household and goals

Who needs coverage
Current coverage and renewal dates
Budget per month
Main goal (protect income, cover final expenses, choose Medicare plan, lower health costs)

Health coverage details

Doctors and hospitals to keep
Prescriptions and dosages
Expected care in the next year
Eligibility or enrollment window (IEP, AEP, OEP, SEP)

Life and annuity details

Income to replace and years
Debts and final expenses
Beneficiaries
Suitability or best-interest facts documented (for annuities)
Health history questions that affect underwriting

Recommendation

Three options compared
Why the recommended option fits
Client questions answered
Client decision and signature

Use rule: Education and organization only. Record the agency, official source, checked date, cost, proof saved and responsible person for every consequential requirement. Unknown means stop and confirm. Example rows are labeled EXAMPLE and are not your data.