Diagnostic and Prescriptive Consult Form

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Your name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Your mailing address* This field is required.
Street Address
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City
State / Province
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Best number to reach you during working hours* This field is required.
Please enter a valid phone number.
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Referred by
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Name of your business* This field is required.
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Website address* This field is required.
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Your title* This field is required.
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Describe your business and the main products and services you offer* This field is required.
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What is your projected annual revenue this year?* This field is required.
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What was your gross annual revenue last year?* This field is required.
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What is your average customer transaction size (if you know it)?
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What is the average lifetime value of a client (if you know it)?
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What are the three biggest challenges you face in your business today?* This field is required.
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What are your top three goals for your business this year?* This field is required.
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What are your top three business goals, longer range? (eg; within the next five years)* This field is required.
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Which professional associations do you belong to?
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Who or what is your target market, or target markets?Please provide as much detail as possible
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Please describe your ideal customer in as much detail as possible - whatever criteria you use to define them eg age, location, occupation, buyer behavior, interests, income etc. (Whatever criteria you use to define them.)
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What is your average client acquisition cost? (If you know it.)
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Please describe your sales process in as much detail as possible (for example someone visits your website, fills out a contact form or calls your office etc).
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What percentage of your customers or clients provide repeat business?* This field is required.
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Who are your three biggest competitors?* This field is required.
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What would you say you do better than your competitors?* This field is required.Eg; what is your competitive advantage?
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What would you say your competitors do better than you?* This field is required.
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What are the top three objections to people not moving forward with a purchase?
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Tell us about ...
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How big is your house email list? Include prospects and customers (past and present.)* This field is required.
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On average, how much do you currently invest on marketing per year?* This field is required.
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How much did you invest in marketing last year?* This field is required.
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Are you happy with your current branding?* This field is required.
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Are you happy with your current website?* This field is required.
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Are you interested in building an expert brand and establishing yourself as a Thought Leader?* This field is required.
YesNo
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How do you get business now?* This field is required.Check all that apply
Attend prospect conferences
Billboard advertising
Blogging
Booth at trade shows
Client Referrals
Cold calling
Direct mail campaigns
Email marketing
Email newsletter
Facebook
Google - Pay Per Click
Google - organic traffic
Influencer paid social media campaigns
Instagram
LinkedIn
Media interviews and public relations
Networking
Print advertising - eg magazines, trade publications etc
Radio advertising
Paid SEO (search engine optimization) services
Podcast
Professionally published book
Sales team generates leads
TikTok
TV commercial(s)
TV guest appearances
TV infomercial
TV paid documentary
Video marketing
Writing guest articles
YouTube
Something else
Other
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What are the top three ways you get new business now?
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Which of your marketing activities have given you the best ROI?
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How do you know?
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Which of your marketing activities have given you the worst ROI?
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How do you know?
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If you invested $100,000 in the stock market, what percentage (ROI) would you consider to be an excellent return?
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If you invested $100,000 in your marketing, what percentage (ROI) would you consider to be an excellent return?
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Imagine that you had a turn-key marketing engine that took the guess work out of your revenue and automatically generated new business from new clients, and more business fro existing clients. What would you like your business to do:your marketing by
We want the same number of clients but we want them to spend more
We want more clients spending what our average transaction size is now
We want the same level of business (the same average transaction size, same number of clients) but we want more profit more customer
We want more clients spending more than what our average clients are spending now
I'm not sure
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What are the top three outcomes that have to happen for you to consider your marketing is successful?* This field is required.
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On a scale of 1-10 (1= not ready, 10= sooo ready), how ready are you to invest in a turn-key marketing engine that attracts, converts and retains new customers, positions you as the best and increases your marketing ROI?* This field is required.
10 - So Ready
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5
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3
2
1= Not ready at all
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Anything else you'd like us to know?
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