Client Intake

Client Intake Form

1. Tell us a bit about yourself. Firstly, your DOB and age, are you married, with kids, and if so, what are their names, ages, genders and do they support your journey?

2. Give us a bit of a timeline regarding your working career, what are some of your key wins, along with any key losses.

3. Let’s talk goals; why are you here? Be as specific as possible, e.g., outline your 12-week, 1 year, 3-year, 5 year and 10-year goals. Visualise and think here, what do you want from your life!

4. If you didn’t achieve these goals, how would that feel to you?

5. On a scale of 1-10, how important is it to achieve your goals and why?

6. What industry is your business in, and what problem does it solve for its target audience?

7. Is your business online, in-person or a combination of both? Please explain in more detail.

8. Please explain your current or future start-up business and if you do not own a business, describe your current job and what that entails. If you own a business, include whether it is a brick and mortar business site that you own or pay rent on, is it remote working, is your business online, do you have staff, and more.

9. What would your friends, family and colleagues say are your top three strengths in business?

10. What would your friends, family and colleagues say are your top three limiting factors in business?

11. How much do you earn per annum – not your business. If you can, provide the last 3-5 years summary of this.

12. If applicable, please provide your business financial data here, such as revenue, profit (EBITA), and the last 3-5 years of growth to date. Feel free to include as much detail as possible here – this is important!

13. If you have this data, do you have a % of revenue per revenue source, as in what % comes from organic, referral, paid advertising etc.?

14. How do your customers hear about you? Please list your website and all social media channels.

15. How many customer inquiries do you get per week?

16. Out of those inquiries, where do they come from? Please break it down.

17. Do you do any paid advertising? If so, what is your weekly, monthly, and annual budget? Please break this down into specific areas if applicable (Google, Facebook etc.)

18. What is one thing about yourself that you are proud of?

19. Is there anything else you would like to add that you feel may be relevant?