SHIFT Advantage Client Data Sheet

SHIFT Advantage Client Data Sheet
Name of Organization
Primary Contact Name

First NameLast Name
Title
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Company Website
Address of Service Requested

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Industry
Number of Employees
What prompted you to seek consultation service at this time?

Other
Have you previously implemented any Emotional Intelligence or Behavioral Strategy training?
If Yes, please describe briefly:
What are your top 3 concerns or challenges within your team/ organization right now?
Which departments or roles are most impacted by these issues?

Other
If Other, describe briefly.
What outcomes are you hoping to achieve with this consultation? ( Check all that apply )

Other
If Other, describe briefly.
Are there specific metrics you'd like to improve ( ie. retention, sales, conflict reports, etc.) ?
Start date for services:

MonthDayYear
Date
Any upcoming events or initiatives we should be aware of?
Which services are you most interested in exploring? ( Check all that apply )
Would you prefer :
Budget Range for Services
Who else will be involved in the decision- making process?
Is there anything else you would like to share with us about your organization, team, or goals?
AGREEMENT/REMINDERS:

I understand that all information I entered in this form will be considered strictly confidential.

The data gathered from this form will only be used as a basis for the type of services the client will need.

I understand that in order to be successful, it is vital to follow the plan agreed by both the Behavioral Strategist Team and the client.
How did you find out about our services?

Other
Schedule a Call a minimum of 48 hours after submission date ( This will give the team time to look it over to better serve you ) AFTER SELECTING A CALL DATE & TIME PLEASE PRESS THE SUBMIT BUTTON BELOW.
Should be Empty: