Confidential Client Intake and Questionnaire
Please take time to answer the following, typing your answers directly into this document and email itto Jeannie at least 48 hours prior to your scheduled call at . Give yourself the space and time to answer each question fully and use as much space as you need. (This will not only help me but help you gain clarity as well!)
Today’s Date:
Personal:
Name:
Birthday (Month and Date):
Mailing Address:
Email Address:
Business:
Your Title:
Company Name:
Tagline: (if you have one)
Mission Statement: (what is your WHY for doing this work?)
Niche/Specialization: (who do you work with?)
Website:
Blog:
Newsletter/Blog or Both:
Are you sending a newsletter? (if so, how often)
How many subscribers do you currently have?
Do you have a blog? (if so, how often are you blogging)
Social Media Profiles:
Facebook Business Page:
# of fans:
Twitter:
# of followers:
LinkedIn URL:
Do you have a presence on any other sites? If so, name them:
Income:
What was your income last year? (either in your job, business and or both)
What is your year to date income?
What is your current monthly income in your business?
What are your income goals for the next 6 months?
What is the income you are looking to achieve within the next 12 months?
How many clients do you currently have?
How many more do you think you can handle?
What are you charging for your services?
How many types of services/programs/products do you have? (please provide some detail or direct me to your website where information is specified)
Marketing
What are you currently doing to market your business? Please include programs, associations, networks, social media, networking (everything you’re currently doing that you can think of
Your Goals:
1.What 3 things specifically do you want to have accomplished within the next 90 days? How about 6 months from now? (what results are you looking for?)
2.If you could wave a magic wand and change 3 things about your business and where you are right now (life too) what would those 3 things be?
3.What have you done so far to reach your BIG business goals, market yourself and make passive revenue.Please share what worked as well as what didn’t.
4. Please list the things that you “tolerate” about your business (or your life as well). This means anything you are putting up with, or are irritated by (even if you think it cannot be changed).
5. Please list all the things that you want to change, improve, or achieve in your businesswithin the next 90 days.
6. What would your version of a highly successful business look like? What would you need to do (or be) to have this?
7. Do you ever tell yourself anything negative about having a highly successful business or making money? Please list those things here.
8. What are your greatest obstacles and or challenges with growing your business? (can be marketing, time, fears, etc.) Please provide as much detail as possible.
9. Is there anything that seems to be getting in the way of growing your business?
10. Are you working in your business full time, part-time, just starting?
11. Is there anything else you need to share with me to help me better understand you and help you achieve the best results possible?
Thank you for filling this out completely. Doing so will create the best possible results for you during our time together.I am so looking forward to working with you!
All My Best,
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