ActionCOACH

Business Name *

Mobile Phone

Office Phone *

First Name *

Last Name *

Email *

Address *

City

State

Postal code

1. What Type of Business Are You In?

If "Other" Type Of Business, Describe Here

2. Please list the specific types of products and/or services you provide for your customers

3. How long have you been in business?

4. How did you acquire this business?

If "Other" how you acquired, please describe

5. Who, other than yourself, is involved in the decision making of your business?

6. Please describe your main challenges. What holds you back? Be specific.

7. How many hours per week do you currently work on average? How do you feel about this?

1. What revenues and profits has your business generated in the past 3 years and what do you project for the current year? If you do not have 3 years history, just include the years you do have. Note: This is completely confidential and will not be shared to anyone.

Current Year Projected:
Revenue Last Year
Profit Last Year
Revenue 2 Years Ago
Profit 2 Years Ago
Revenue 3 Years Ago
Profit 3 Years Ago

2. What percentage growth do you expect to see in the next 12 months?

3. How do you see this growth being achieved?

1. What percent of your time, on average do you devote to the following activities:

Strategic Planning
Business Development and Marketing
Day-to-day Operational and Tactical Requirements
Trouble-shooting and Fighting Fires
Other

If "other" in percentage time you devote to activities, please describe

2. Please describe your strengths as a business owner:

3. Please describe the areas where you need improvement as a business owner:

4a. On a scale of 1 to 10, please rate your SKILLS in the following key areas with 1 being the least possible and 10 being the highest.

Leadership
Marketing
Sales
Finance
Operations
Strategic Planning
Goal Setting
Customer Service
Decision Making
Employee Development

4b. On a scale of 1 to 10, please rate your INTERESTS in the following key areas with 1 being the least possible and 10 being the highest.

Leadership
Marketing
Sales
Finance
Operations
Strategic Planning
Goal Setting
Customer Service
Decision Making
Employee Development

5. What are the biggest frustrations you have with your own business?

6. What are your hobbies? How do you currently spend time outside of your business?

7. If you had enough time and financial resources to do anything you choose, how would you spend your time outside of your business?

8. Which statement best describes you? Tick/Check One...

I’m an action oriented person who is most comfortable when in charge.

I’m a ‘people’ person who values friendships in my work relationships and likes to build consensus.

I’m calm and cool under pressure and like to make logical rather than emotional decisions.

I like to study lots of information before making decisions.

1. How many employees, on average, have you employed in the past 3 years?

Currently
1 Year Ago
2 Years Ago

2. What team or staff challenges are you currently facing on a regular basis?

3. If you could make any changes to your team, what would they be and why?

1. If there was one thing you could change about your business in the next 90 days, what would it be and why?

2. Is there any additional information you feel would be valuable for our discussion?