Intake Form

Every one of our clients starts their journey with this Intake Form and Strategy Session with our Head of Coaching.

Tell us about you, your business, your personal and professional targets.

Let's work together to help you succeed in your business!

First Name *

Last Name *

Phone *

Email *

Business Type *

Industry *

Business Structure *

Corportation

Sole Proprietorship

Other

STRATEGY

Why did you become a Business Owner and what is your business vision? *

What are your company's core values? *

What is your core product or service? *

How does that product or service solve your clients problem(s)? *

List all Business Programs you’ve completed: *

What would you need to achieve with Future In Media to consider it successful? *

OPERATIONS

Ability to plan *

Good

Average

Poor

Ability to lead/manage *

Good

Average

Poor

Ability to create a harmonious, friendly team *

Good

Average

Poor

Ability to manage time *

Good

Average

Poor

How long have you been in business? *

Which days of the week will you be open for business? *

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How many hours per week do you work? *

What stage is your business currently in? *

Just Started

Growing

Plateaued

Decreasing in growth

Please list the top 3 challenges you have with running your business.

Challenge #1: *

Challenge #2: *

Challenge #3: *

REVENUE

How comfortable are you with running / managing business financials? *

No Financial Experience

Experienced, but uncomfortable

Comfortable

Financial Expert

Are you making sufficient revenue from your business to provide for your growth and future? *

Yes

No

What was your revenue per year for the last two financial years?

Revenue 2 Years Prev. *

Revenue Prev. Year *

What is your revenue goal? *

Do you monitor cash flow and P & L? *

Yes

No

MARKETING

Website *

Do you have an understanding of a sales funnel? *

Yes

No

Facebook Page URL *

Linkedin Page URL *

X Page URL *

TikTok Page URL *

Youtube Channel URL *

Instagram Page URL *

Facebook Review URL *

Google Review URL *

Who is your ideal client/customer? (Please provide as many details as possible.) *

What problem will you solve for your clients? *

SALES

Do you have a sales team? *

Yes

No

How much will the average customer spend on your products/services? *

Rate your sales conversion ratio? (%) *

Good

Average

Poor

I'm not sure

BUSINESS GOALS & TARGETS

Do you have a strong and clear written plan for the next 1-3 years in these areas:

Business/Career *

Yes

No

Health & Fitness *

Yes

No

Financial *

Yes

No

Personal *

Yes

No

Do you have an exit strategy? *

What has been your biggest success in business? *

Are you looking to create a business to sell in the future? What does that look like? *

Do you have one or more mentors whom you contact for guidance at least once a month? *

Yes

No

Are you open to implementing new strategies to improve your overall results? *

Yes

No

How often do you check your results? *

Everyday

Every Month

infrequently

Every week

Every 90 days

Not at all

Choose the word that best describes you: *

Outgoing

Reserved

People-orientated

Comfortable