Credit Medical History
How long has your credit history been on record?
*
Less than 1 year
1–3 years
4–7 years
8+ years
Have you ever received professional care for your credit before?
*
Yes, from a credit professional
I attempted self-care
No, this is my first evaluation
Which symptoms are currently showing in your credit profile? (Select all that apply)
*
Missed or Late Payments
Accounts in Collections
Charged-Off Accounts
Repossession
High Credit Utilization
Medical Bills
Student Loans
Bankruptcy
No symptoms
How would you describe the severity of these symptoms?
*
Mild — manageable
Moderate — concerning
Severe — overwhelming
Credit Lifestyle & Habits
How consistent are you with on-time payments?
*
Always consistent
Mostly consistent
Occasionally inconsistent
Frequently inconsistent
How would you describe your credit utilization habits?
*
Low and well-managed
Moderate but controlled
High and difficult to manage
Maxed out
Treatment Readiness
How prepared are you to follow a credit care plan?
*
Fully committed to treatment
Open to guidance
Currently observing and learning
When are you hoping to see improvement in your credit health?
*
Immediate intervention needed
Short-term recovery (30–60 days)
Gradual improvement (3–6 months)
Preventative care only
How much guidance do you feel you’ll need during your credit repair process?
*
I’m comfortable following a plan on my own
Some guidance and occasional check-ins would help
I want regular guidance and accountability
How important is it for you to have direct access to coaching for strategy or questions?
*
I don’t need coaching calls
Periodic check-ins are helpful
Ongoing coaching and direct access are important
Are you preparing for a major financial goal?
*
No immediate plans
Possibly within the next year
Yes, within 6 months
Yes, within the next 90 days
Patient Notes
What concerns you most about your credit health right now?
*
🩺
Credit Health Screening
Full Name
*
Email
*