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Pre-Appointment Review - Page Two

PERSONAL INFORMATION


Your middle name?



Your date of Birth?
(dd/mm/yyyy)
Your gender?

Your height?

Your weight?


YOUR HOME




formDemo.html

NATIONALITY AND IDENTIFICATION

Please specify your nationality? (select one or more)



formDemo.html

YOUR HEALTH AND SPORTS

Do you have any significant medical history now or in the past? Do you take prescription drugs? If so, briefly describe as appropriate.

Are you a smoker or non-smoker of cigarettes, marijuana or heaver drugs?

How would you describe your health?

SPORTS AND ACTIVITIES
Please list your current sports and activities?


formDemo.html

YOUR IMMEDIATE FAMILY

Name of your partner/spouse?

Birthdate of partner/spouse?
(dd/mm/yyyy)
Your personal marital status?


CHILDREN:
Number of Children?

How many children and adults are dependent on you?


Name of your first child?

Birthdate of first child?
(dd/mm/yyyy)

Name of your second child?

Birthdate of second child?
(dd/mm/yyyy)

Name of your third child?

Birthdate of third child?
(dd/mm/yyyy)

Name of your fourth child?

Birthdate of fourth child?
(dd/mm/yyyy)

CLICK THIS BUTTON TO SUBMIT THIS INFORMATION TO LEGATO
For privacy protection, this information directly connects into our business management system (Salesforce.com).  
Copyright 2021 - Legato Wealth Management Inc.

Copyright 2023- Legato Wealth Management Inc.