Connect Me Complete the form and we will reach out to you to connect you with the perfect individual or company Connect Name * Name First First Last Last Email * Phone * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia New Option Wisconsin Wyoming Who can we connect you with? * Accountant Attorney Debt Reduction Specialist Financial Planner Insurance Agent (Disability) Insurance Agent (Life) Insurance Agent (Property Casualty) Investment Advisor Mortgage Lender Realtor Student Loan Specialist OtherOther Accountant What accounting services are you looking for? * Yearly Taxes/Tax Preparation Regular Bookkeeping Financial Statement Management (Personal) Financial Statement Management (Business) What assets do you have? (Check all that apply) * Investment Accounts Business Ownership Rental Real Estate (Residential) Rental Real Estate (Commercial) OtherOther Attorney What attorney services are you looking for? * Bankruptcy Business (Corporate) Criminal Defense Estate Planning (Legal Documents) Family Matters Immigration Intellectual Property (IP) Personal Injury Real Estate Taxes OtherOther Tell us a little more about your situation Debt Reduction/Restructure What debt do you want to reduce/restructure? * Credit Cards Mortgage HELOC Personal Loans Student Loans OtherOther What is your credit score? * Total Outstanding Credit Card Debt Total Outstanding Mortgage Debt Total Outstanding HELOC Debt Total Outstanding Personal Debt Total Outstanding Student Loan Debt Total Outstanding Other Debt Tell us a little more about your situation Insurance (Auto/Homeowners/Umbrella) Which property casualty items do you need help with? * Auto Homeowners Renters Umbrella OtherOther What questions do you have about auto insurance? * Get Independent Quotes Insurance Coverage Review General Questions Explain your auto insurance situation/question What questions do you have about homeowners insurance? * Get Independent Quotes Insurance Coverage Review General Questions Explain your homeowners insurance situation/question What questions do you have about renters insurance? * Get Independent Quotes Insurance Coverage Review General Questions Explain your renters insurance situation/question What questions do you have about umbrella insurance? * Get Independent Quotes Insurance Coverage Review General Questions Explain your umbrella insurance situation/question Explain your other insurance situation/question Upload Declaration Pages Drop a file here or click to upload Choose File Maximum upload size: 516MB Disability Insurance How can we help you with disability insurance? Purchase Disability Insurance Disability Insurance Education General Disability Insurance Questions Current Physician Status * Attending Resident/Fellow Medical Student What is your specialty? * Current Salary * Date of Birth * Gender * Female Male Current Disability Insurance Information * Group Disability Insurance Individual Disability Insurance No Disability Insurance Total Monthly Coverage (Group Long Term Disability) * Total Monthly Coverage (Individual Long Term Disability) * What questions do you have about disability insurance? * Life Insurance How can we help you with disability insurance? Purchase Life Insurance General Life Insurance Questions Current Physician Status * Attending Resident/Fellow Medical Student What is your specialty? * Current Salary * Date of Birth * Gender * Female Male Current Life Insurance Information * Group Life Insurance Individual Life Insurance No Life Insurance Total Group Life Insurance * Total Individual Life Insurance * What questions do you have about life insurance? * Investment Advisor Checkboxes Portfolio Review Retirement Account Opening/Rollover Investment Account Opening/Rollover General Investment Questions What questions do you have about investments? * Mortgage Lender What kind of mortgage services are you looking for? Need Pre-Approval/Qualification Want to shop rates from different lenders Under contract, but need a new lender ASAP Just want basic information on the home buying/loan process Want to see the best type of mortgage for my situation Refinance/Cash Out Refinance What kind of loan are you looking to get? Conventional (15 year or 30 year) Jumbo (Loan amount of $647,200) Physician Loan FHA VA Construction Loan I have no idea Realtor What do you need a realtor for? * Buy Property Sell Property What kind of home are you looking to purchase? * Primary Residence Vacation Home Investment Property What locations are looking to purchase in? * Price Range (Min.) Price Range (Max.) Bedrooms (Min.) Bathrooms (Min.) Have you been pre-qualified or pre-approved yet? * Yes No Are you working with a lender yet? * Yes No What other information should we know about your home purchase? What kind of home are you looking to sell? * Primary Residence Vacation Home Investment Property Address of property you want to sell? * Desired Selling Price * What other information should we know about your home sale? Student Loan Assistance What student loan assistance do you need? * Looking to Restructure/Refinance Public Service Loan Forgiveness (PSLF) Pay Down Strategies Total Student Loan Balance Current Interest Rate on Loans Other Describe how you would like Physician Helpers to connect you If you are human, leave this field blank. Submit Start Over Δ
