New Entrepreneurial Client Intake Form
What's your name?
How would you rate your stress in the past three months?
Extremely high
Very High
Somewhat High
Moderate
Low
I'm not feeling stressed at all
How happy are you with where you are at in your business?
Everything is going really well, I just want to grow and scale
There are some things I want to change but so far things are working
I'm feeling like I'm spinning my wheels and getting no where
I feel stuck and I'm not even sure where to start
What are your primary sources of stress and/or burnout? (please select all that apply)
Work
Family
Friends
Significant Other
Health
School/Education
Self-talk/Inner Critic
Anxiety
Other
What's working well for you in your business?
What needs to be changed in order for you to reach the success you want in your business?
What are your current offers/services/products?
Are your offers, services, packages or products something you want to refine/discuss with Avery
Yes
No
Maybe
Please check off all of the assets your business currently has (this is not a comprehensive list and not all businesses require all of these options, so please don't feel stressed if you feel you're "missing something"
A Clealy Defined Niche
Effective Messaging
A Business Plan
An Effective Marketing Plan
Website
Email List
Email Opt-In
Sales Funnel
Converting Sales Funnel
Client Generation Platform (social media, podcasting, networking etc)
A Validated Offer
Brick and Mortar Location or Local Marketing Strategy
Have you worked with other coaches before? If so, what worked well for you and what didn't work well?
Why are you looking to work with me one-on-one?
We will set goals and action plans on our first call, but do you have some ideas for what you'd like to set goals around?
Anything else you'd like me to know before our first call?
Submit