KMI ESI™ Request Form
Purpose: This form initiates a request for the Ethical Service Index (ESI™). KMI reviews each submission to assess leadership alignment, organizational context, and strategic fit. Selected organizations will be invited to a follow-up discussion to define scope and determine next steps. The Ethical Service Diagnostic (ESI™) is a structured, paid engagement designed to ensure precision, alignment, and measurable outcomes before full advisory work begins.
Organization Overview
1. Organization Name
*
2. Industry / Sector
*
Please Select
Public Sector / Government
Corporate / Private
Non-Profit / Mission-Driven
Faith-based
Association / Education
Other
3. Organization Size
*
Please Select
1-50
51-250
251-1,000
1,000+
4. Primary Service Channels (Select all that apply)
*
In-Person
Call Centre / Phone
Digital / Online
Hybrid
5. Website URL
*
Leadership & Contact Information
1. Full Name
*
First Name
Last Name
2. Phone Number
*
Format: (000) 000-0000.
3. E-mail
*
example@example.com
4. Title / Role
*
5. Department
6. Are you the decision-maker for this engagement?
*
Yes
Part of the decision-making group
Exploring on behalf of leadership
Current CX Reality
1. How would you describe your current customer experience environment?
*
2. Which of the following challenges are you currently experiencing? (Select all that apply)
*
Inconsistent service delivery across channels
Escalations or complaints lacking resolution patterns
Gaps between leadership expectations and frontline execution
Customer trust concerns
Staff uncertainty in handling complex or high-stakes interactions
Lack of measurable CX standards
Other
3. Where do breakdowns occur most often?
*
Frontline interactions
Manager-level decision-making
Policy/process gaps
Cross-department coordination
Leadership alignment
Measurement & Accountability
1. How do you currently measure customer experience performance?
*
2. Which metrics do you actively track? (Select all that apply)
*
Customer Satisfaction (CSAT)
Net Promoter Score (NPS)
Complaint volumes
Resolution time
Employee engagement
None / Limited measurement
3. How confident are you in the accuracy of your CX data?
*
High confidence
Moderate confidence
Low confidence
Unsure
Strategic Priorities
1. What are your top 1–3 CX priorities over the next 6–12 months?
*
2. What is driving the need for improvement now?
*
Growth / scaling operations
Customer retention concerns
Reputation risk
Leadership transition
Transformation initiative
Regulatory / compliance pressures
Readiness & Investment
1. What stage best describes your organization?
*
Exploring options
Actively evaluating solutions
Ready to initiate within 3 months
2. What level of investment has been allocated for CX improvement?
*
Under $15,000
$15,000–$30,000
$30,000–$75,000
$75,000+
To be determined
ESI Diagnostic Alignment
1. What would a successful outcome from this diagnostic look like for your organization?
*
2. What prompted your interest in the PRISM™ CX Methodology?
*
Executive Briefing Request
The ESI Diagnostic is delivered following an Executive Briefing to ensure alignment with your organizational priorities and leadership context.
Would you like to schedule an Executive Briefing?
*
Yes
Not yet
How did you hear about us?
*
Please Select
Newspaper
Internet
Magazine
Other
Please Specify
*
Submit
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