• Consultation & Service Request Form

  • One Mission. Two Roles. Endless Impact.

  • Thank you for your interest in Tailored Business Consulting. Please complete this form so we can understand your business, goals, current challenges, and the type of assistance you are requesting. Submitting this form does not guarantee acceptance of a consulting engagement; services are scheduled based on availability and scope of work.

  • 1. CONTACT INFORMATION

  • Format: (000) 000-0000.
  • Preferred Method of Contact

  • 2. TELL ME ABOUT YOUR BUSINESS

  • Which best describes you?
  • Do you currently have an active business entity registered with the State?
  • Do you currently hold any licenses, certifications, registrations, or provider numbers related to this business?

  • 3. CONSULTING AREA

  • What type of consulting or assistance are you interested in? Select all that apply.

  • 4. YOUR CONSULTING NEEDS

  • 6. CONSULTATION FORMAT

  • Office Hours:

    Tuesday-Wednesday-Thursday 9:00 AM-4:00 PM  |Saturday 10:00 AM-3:00 PM

  • How would you prefer to meet?
  • Schedule your Consult

  • 10. REQUIRED NON DISCLOSURE AGREEMENT

  • Non-Disclosure Agreement Requirement
  • Tailored Business Consulting may share proprietary business strategies, templates, processes, documents, educational materials, operational methods, concepts, and other intellectual property during the consulting relationship. An executed NDA may be required before proprietary consulting materials or detailed business processes are provided.
  • 11. COMMUNICATION POLICY (Select All that apply)*

  • 12. CONSULTING DISCLAIMER

  • Tailored Business Consulting provides business consulting, education, strategy, administrative guidance, and operational support based on professional and practical knowledge and experience.
  • Specific business, financial, licensing, approval, funding, reimbursement, or revenue outcomes are not guaranteed. Results depend on many factors, including the client's active participation, timely completion of assigned tasks, financial investment, startup expenses, licensing fees, application requirements, regulatory requirements, third-party agencies, market conditions, and other circumstances outside the control of Tailored Business Consulting.
  • Clients are expected to remain actively involved throughout the consulting process. Failure to provide requested documentation, complete required steps, respond to communications, meet submission deadlines, pay required third-party fees, or fulfill regulatory requirements may delay or prevent completion of the client's goals.
  • Tailored Business Consulting is not acting as a law firm, accounting firm, tax professional, financial advisor, licensing authority, Medicaid agency, or governmental regulatory body. Consulting services do not constitute legal, tax, accounting, financial, or regulatory advice. Clients should consult the appropriate licensed professional or governmental authority when specialized advice is required.
  • Final business decisions, applications, submissions, compliance responsibilities, and outcomes remain the responsibility of the client.
  • 13. PAYMENT & REFUND ACKNOWLEDGMENT*

  • 14. FINAL ACKNOWLEDGMENT

  • How did you hear about Tailored Business Consulting?
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Consultation & Plan Options

    prevnext( X )
    Initial Consultation- 45 mins. Review goals, questions, current challenges and recommended next steps.
    Initial Consultation- 45 mins

    Review goals, questions, current challenges and recommended next steps.

    $75.00$75.00
      
    Total
    $0.00$0.00
    Debit or Credit Card
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