Client Intake Form-Men
Name______Date______
Ph: w)______m)______Email______
Occupation ______
Spouse______Children ______
Email______Birthday ______-______
Address (home)______
Address (work)______
Sizes: _____ Jacket_____ Pant: w-_____ Inseam-______Dress Shirt x Sport Shirt______Shoe______Boxers______Briefs______Undershirt______
Height______Weight______Hair Color _____ Eye Color______
The majority of the time I dress in:
____Business Professional ___Business Casual ____ Very Casual
My favorites:
Color ______
Movie ______
Author______
Restaurant______
Clothing Store ______
Book ______
Vacation Destination ______
Actor______
Actress ______
Car ______
Cologne______
Skin Care______
2. My best time of day is ____morning ____ afternoon _____evening.
3. I prefer that you communicate with me by _____ phone _____ email _____ whichever is most efficient.
4. My purpose in life is ______
5. I am inspired by ______
6. I learned to dress from______
______
7. I want to improve or expand/extend use of the following skills or develop
and create the following components to my life and / or my business:
A.
B.
C.
8. Please check one:
______I want to polish my presentation to the fullest. Please advise accordingly.
______I just want to have fun and treat myself to some new clothes.
9.. I want to accomplish the following measurable or observable results:
A.
B.
C.
10. I want to invest approximately $______in clothing over the next _____ weeks.
11. I need assistance with appropriate dress, presentation skills for the following events:
______on ______
______on ______
______on ______
12. I understand that there is a one-time New Client Intake Fee of $200 and am interested in
______a 12-month retainer plan customized for my needs entitling me to one complimentary hour/quarter and weekday rates no matter when we work together
______hourly fees of $170 or $180/hour (evenings/weekends)
Both plans include a one-time intake fee of $200
13. My exercise routine consists of:______
14. I have the following questions/comments:
A.
B.
C.
Please keep a copy for your own records and return to: