CONSULTING INTAKE FORM

Before we start working together, please take a few minutes to let me know a bit more about you and your business.

Some of the information below is definitely a bit sensitive, but the more open you can be with me, the better results we will achieve together. Trust me… I’ve been there, failed that. I can write a few books about everything I’ve messed up in my business career. Remember that your biggest failures and challenges often represent your biggest opportunities!

NOTE: everything is strictly, 100% confidential.

*anything marked with an asterisk is required

Name

First Name

Last Name

Email Address

Phone No.

(###)

###

####

Company Name

Enter your company name.

Website URL

enter your website URL if you have one

http://

Describe your business in 50 words or less

Dream a little... what is the in-your-wildest-dreams outcome we would achieve from working together?

Why does this represent an ideal outcome?

Where would you like to see this business 3 years from now?

Why?

Dig in to the answer above and clarify exactly why you're chasing that vision

What are your biggest business challenges right now?

Are there any life issues or factors that are affecting your business?

The more honest and open you can be with me, the more I can help you - we can also discuss this during our sessions if you prefer.

What % of your time do you spend ‘putting out fires’ (dealing with issues and crises) and what types of fires do you typically have to deal with?

How many full-time (or full-time equivalent) employees do you have? How many of those would you describe as executive/management staff?

Pro-rate and total up your part-time staff (e.g. 2 employees @ 20hrs/week = 1 Full-Time Equivalent)

Please outline your management team and their roles (1 sentence each is fine)

What were your revenues and net profit from last fiscal year?

If you'd prefer not to share, we can discuss this later

What is your revenue and net profit this fiscal year so far?

If you'd prefer not to share, we can discuss this later

Do you have any debt? If so, how much? What are your monthly payments?

Do you have a regular reporting system? How often do you report on key metrics?

In addition to the typical metrics (revenue, profit, COGS, etc.), what are the top 3-5 other metrics you track (if any)?

PLEASE RANK THE FOLLOWING STATEMENTS FROM 1 TO 10 (1=strongly disagree, 10=strongly agree)

I have a business that works for me and supports my ideal life

I am paid an adequate salary for my efforts

My staff understand what our goals are and what their role is in achieving those goals

We have a defined mission and values and live them regularly

I have a strong vision of where I want my business to be in 3 years

My staff have a clear understanding of our vision and how to get there

I spend most of my time working on projects and tasks that motivate and fulfill me

I could take 4 weeks off and the business would run fine without me

I find running my business enjoyable and fun

Our customers are thrilled with our service/products