Company Name

First Name

Last Name

Email Address

Mobile Number

Website Address

Are you the sole owner of the business? Are you the sole owner of the business? Yes, I am the Sole Owner No, I have one other partner No, I have more than one other partner

Which of these best describes your business size? Your annual revenue is between? Which of these best describes your business size? Your annual revenue is between? $0 and $250,000 $250,000 and $500,000 $500,000 and $1,000,000 $1,000,000 and $2,000,000 $2,000,000 and $3,000,000 $3,000,000 to $4,000,000 $4,000,000 to $5,000,000 $5,000,000 to $10,000,000 $10,000,000 or more

How long has your business been operating? How long has your business been operating? Brand New 6 to 12 Months 1 to 2 Years 2 to 3 Years 3 to 5 Years 5 or more years

Are you a franchisee? Are you a franchisee? Yes No

Approximately how many team members do you employ (do not count subscontractors)? Approximately how many team members do you employ (do not count subscontractors)? None other than myself 1 2 to 5 6 to 10 11 to 15 16 or more

Which best describes your profit performance? Which best describes your profit performance? We consistently achieve our annual profit targets We make a profit every year, but we usually miss our targeted amount Profit seems to vary from year to year, some years we make profit, others we don't Most years we do not make a profit To be honest, we have no idea if we are profitable or not

Which areas are you looking to improve in your business? (You can select multiple choices) Which areas are you looking to improve in your business? (You can select multiple choices) Capital Strategy Leadership Team Systems Marketing Sales Delivery Finance Admin Profits

Which best describes your motivation level as a business owner right now? Which best describes your motivation level as a business owner right now? I have a burning desire to grow and improve my business, I'm ready to take action and make things happen and I feel very positive about the potential of my business I have a burning desire to grow and improve my business, I'm ready to take action and make things happen but I'm not sure about the potential of my business I would like to grow and improve my business, but my motivation level and belief in my business are not as strong as they should be

Which best describes your relationship with your business right now? Which best describes your relationship with your business right now? I feel like I am in control of my business, I use my time wisely and I feel like I have achieved a good balance I am somewhat in control of my business and although the business demands alot of my time most days, I feel I have achieved some balance I don't really feel in control of my business, I am swamped time wise and I feel out of balance in my business

Business Coaching? Business Coaching? I have used a Business Coach in the past, found it to be worthwhile and ready to try it again I have used a Business Coach in the past but wasn't overwhelmed with the results but would like to give it another shot I have never used a Business Coach, but I have a good idea of how it works and I think it would be worthwhile and benefit my business I have never used a Business Coach, not really sure how it works but I would like to find out how it can benefit my business

Please add any additional comments that you feel would give us a better idea about you and your business