Client Check-In

[[[["field11","equal_to","Yes"]],[["show_fields","field12"]],"and"],[[["field29","equal_to","Poor"]],[["show_fields","field28,field27"]],"and"],[[["field31","equal_to","Yes"]],[["show_fields","field122"]],"and"],[[["field122","equal_to","1"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123"]],"and"],[[["field122","equal_to","2"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124"]],"and"],[[["field122","equal_to","3"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124,field74,field75,field76,field77,field78,field79,field125"]],"and"],[[["field122","contains","4"]],[["show_fields","field42,field43,field44,field45,field31,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124,field74,field75,field76,field77,field78,field79,field125,field80,field81,field82,field83,field84,field85,field126"]],"and"],[[["field122","equal_to","5"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124,field74,field75,field76,field77,field78,field79,field125,field80,field81,field82,field83,field84,field85,field126,field86,field87,field88,field89,field90,field91,field127"]],"and"],[[["field122","equal_to","6"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124,field74,field75,field76,field77,field78,field79,field125,field80,field81,field82,field83,field84,field85,field126,field86,field87,field88,field89,field90,field91,field127,field92,field93,field94,field95,field96,field97,field128"]],"and"],[[["field122","equal_to","7"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124,field74,field75,field76,field77,field78,field79,field125,field80,field81,field82,field83,field84,field85,field126,field86,field87,field88,field89,field90,field91,field127,field92,field93,field94,field95,field96,field97,field128,field98,field99,field100,field101,field102,field103,field129"]],"and"],[[["field122","equal_to","8"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124,field74,field75,field76,field77,field78,field79,field125,field80,field81,field82,field83,field84,field85,field126,field86,field87,field88,field89,field90,field91,field127,field92,field93,field94,field95,field96,field97,field128,field98,field99,field100,field101,field102,field103,field129,field104,field105,field106,field107,field108,field109,field130"]],"and"],[[["field122","equal_to","9"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124,field74,field75,field76,field77,field78,field79,field125,field80,field81,field82,field83,field84,field85,field126,field86,field87,field88,field89,field90,field91,field127,field92,field93,field94,field95,field96,field97,field128,field98,field99,field100,field101,field102,field103,field129,field104,field105,field106,field107,field108,field109,field130,field110,field111,field112,field113,field114,field115,field131"]],"and"],[[["field122","equal_to","10"]],[["show_fields","field42,field43,field44,field45,field65,field66,field123,field68,field69,field70,field71,field72,field73,field124,field74,field75,field76,field77,field78,field79,field125,field80,field81,field82,field83,field84,field85,field126,field86,field87,field88,field89,field90,field91,field127,field92,field93,field94,field95,field96,field97,field128,field98,field99,field100,field101,field102,field103,field129,field104,field105,field106,field107,field108,field109,field130,field110,field111,field112,field113,field114,field115,field131,field139,field117,field118,field119,field120,field121,field132"]],"and"]]
1
First Namefirst name
Last Namelast name
Phonephone number
Time of Appointment
Dateof appointment
Appointment Timeof appointment
Has anything changed in your finances since the last time we spoke?
Please describe.more details
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Is this your first appointment?

Are your wages being garnished now?

Have any of your assets been seized in the past 10 days?

Are you facing foreclosure in the next 7 days?

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How can we improve?
If you are unhappy, please tell us how to improve.more details
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Do you owe money to any company or person, that does NOT appear on your credit report?

Creditor 1
Full Namefull name
Addressaddress
Amount of debtamount of debt
What type of debt is it?What type of debt is it?
What is your account number?What is your account number?
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 2
Full NameFull Name
AddressAddress
Amount of debtAddress
What type of debt is it?your full name
What is your account number?What is your account number?
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 3
Full NameFull Name
AddressAddress
Amount of debtAmount of debt
What type of debt is it?What type of debt is it?
What is your account number?your full name
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 4
Full Nameyour full name
AddressAddress
Amount of debtyour full name
What type of debt is it?your full name
What is your account number?What is your account number?
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 5
Full Nameyour full name
AddressAddress
Amount of debtAmount of debt
What type of debt is it?What type of debt is it?
What is your account number?What is your account number?
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 6
Full Nameyour full name
AddressAddress
Amount of debtAmount of debt
What type of debt is it?What type of debt is it?
What is your account number?What is your account number?
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 7
Ful Nameyour full name
AddressAddress
Amount of debtAmount of debt
What type of debt is it?What type of debt is it?
What is your account number?What is your account number?
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 8
Full Nameyour full name
AddressAddress
Amount of debtAmount of debt
What type of debt is it?What type of debt is it?
What is your account number?What type of debt is it?
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 9
Full Nameyour full name
AddressAddress
Amount of debtAmount of debt
What type of debt is it?What type of debt is it?
What is your account number?What is your account number?
Name of any co-signer on the debtName of any co-signer on the debt
Creditor 10
Full Nameyour full name
AddressAddress
Amount of debtAmount of debt
What type of debt is it?What type of debt is it?
What is your account number?What is your account number?
Name of any co-signer on the debtName of any co-signer on the debt
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