Client Intake Form

    Client Information

    Contact Details

    How may I contact you?

    Employment Information

    Personal Information

    Business Information

    How long have you been in business?

    What is the nature of your business?

    Please be specific, how many employees do you have and explain their role in the business. IE: Full-time, part-time, and their role.

    How many sub-contractors do you have in your business and how much is sub to them?

    Where do you normally work?

    What do you expect to get out of these coaching sessions?

    Tell me something about yourself that you think I should know to coach you better?

    Briefly share your overall business and life goals. Where do you see yourself in

    Where are you at right now?

    On a scale of 1 -10, how happy are you with your life right now, and why do you feel this way?

    On a scale of 1-10, how do you feel about your schedule, use of time, and overall busyness?

    On average, how many hours of sleep do you get per night?

    What Key Frustrations are you currently experiencing in your business?

    Survive-Level System Questionnaire

    My business revenue covers my operating expenses.

    I pay myself a regular salary that covers my personal needs.

    I am on top of my finances both personally and in my business.

    My personal and business debt load is manageable.

    I exercise regularly, eat healthfully, and get adequate sleep.

    I (and those close to me) have good physical and mental health. (Includes being free of drug/alcohol addictions)

    I (and my team) am safe from threat of physical harm and /or mental/emotional abuse at work and at home.

    I have the skills and knowledge I need to ensure the survival of my business

    I am compliant / up to date on all required legal, licensing, insurance, permits etc. for my industry.

    My relationships at home and work are healthy and supportive.

    The industry my business is in is stable and growing.

    I feel like I have control over whether good or bad things happen to me and my business.

    I had adequate insurance coverage to ensure theft, accidents, ill health, and other unexpected events won’t create undue hardship for me / my business.

    I have a proficient bookkeeper and accountant and/or am proficient in bookkeeping/accounting myself.

    I have all of the basic equipment/tools I need to run my business effectively.

    I have proper contracts in place for my dealings with all clients, employees, and suppliers.

    Strive-Level Questionnaire

    I am clear on the goals and priorities of myself and my business.

    I am clear on my optimal/ideal role within the business.

    I understand the industry I am in and its future directions.

    I have the specific skills and knowledge I need to grow my business to the next level.

    I know who my customers are and how to attract them.

    I am effective communicator (both verbally and in writing)

    I engage in conflict constructively (rather than avoid it)

    I am good at giving and receiving feedback

    I am able to focus and concentrate on the task at hand.

    I make decisions with ease and confidence.

    I engage in regular daily and weekly planning

    I plan and manage my time effectively.

    I set and successfully achieve goals in my business and personal life.

    My work and home environments are optimally organized.

    I create and use systems to enhance quality and efficiency in my business and personal life.

    I demonstrate the discipline to endure short-term discomfort to reach long-term goals.

    I seldom work long hours.

    I feel satisfied with my business progress and achievements so far.

    I stick to a concrete plan for managing my finances/investments.

    My business has grown in revenues and/or profitability every year.

    I have received awards/recognition for my business accomplishments.

    I have clearly defined my primary, secondary and tertiary target markets.

    I have a business and/or strategic plan and refer to it regularly.

    I seldom feel stressed or overwhelmed.

    I am good at the managing the performance of myself and my employees.

    Alive-Level Questionnaire

    I have a written set of core values and principles that govern the actions and decisions of myself and my team.

    I have effective decision-making systems in place.

    I have a mentor, coach and/or mastermind group.

    My daily business choices are aligned with my core values and principles.

    My primary relationships are aligned with my values and principles.

    My employees, customers and/or suppliers are aware of my values and principles.

    I love my work/business.

    I know my strengths and the areas of expertise I wish to use in my work.

    I have the opportunity to use/develop these strengths and areas of expertise in my work each day.

    I am clear on my ideal role in my business and spend the majority of my time in this role.

    I (and any employees) am (are) clear on the core strengths, expertise and competitive advantages of our products and services.

    I am confident and effective in promoting my business and enjoy doing so.

    I am comfortable with mistakes and am skilled at learning from these mistakes.

    I know my mission purpose in life and my business is aligned with it.

    I am clear on the core purpose/mission of my business.

    I have a clear, concrete and tangible vision for my business and my life.

    I feel confident in my ability to realize my vision for my business and my life.

    I actively pursue continuous learning and growth both personally and professionally. (You should be able to give specific, recent examples)

    I have above average fitness and health and enjoy my health and fitness routine.

    I confidently express my authentic self in life and work.

    I am easily able to discern which opportunities are a fit and which are not.

    My home is calming and energizing place to be.

    My workplace is a focused, productive, and energizing place to be.

    I maintain a healthy balance between life and work.

    Thrive-Level Questionnaire

    I love my work as it is aligned with all of my passions

    I love my life as it is aligned with all of my passions.

    My relationships both inside and outside of work are highly functional and extremely satisfying.

    I am making a positive difference in the world through my business.

    I am clear on the legacy I most want to leave in my life and work.

    I find it effortless to stay aligned with my purpose, values, and principles.

    I have customized my time and energy management strategies to optimize my performance.

    I am focused, energized and in the flow in all areas of my life and work.

    I am excited to get up every day.

    I easily sustain an optimal level of health.

    I easily make decisions that are in alignment with my values in live and work.

    I focus on win/win solutions.

    My passion, rather than my finances, influences my choices in life and work.

    My financial standing allows me to do everything that I dream of doing.

    I have a clear sense of meaning and purpose in everything I do in my life and work (even events that are negative or beyond my control).

    I can’t image doing anything other than what I am doing in my life and work (because this is so much who I am).

    I have a high confidence/trust in my ability to create the results I set out to create.

    The social and environmental impact of my business is a positive one.

    My business runs effectively even when I’m not there.

    I work in my business when I want to, not because I have to.

    Succession plans are in place for all key roles in the business.

    Overall Life Satisfaction Ratings

    My Energy

    My Passion for Life

    My Passion for work

    My Success

    My Health

    My Relationships

    My Confidence

    Overall Business Satisfaction Ratings


    Finance/ Accounting


    Human Resources

    Strategic Planning


    Business Income

    Business Reputation

    Owner Role in Business

    Business System Checklist

    Scripts and best proactive policy for answer the phone.

    Station and or Policy for receiving and opening Mail

    Courier # and vendor relationship setup in advance

    Systems for tracking purchasing and maintaining of office supplies and equipment

    Faxing and e-mailing (how-to-documented, emailing signature, privacy policy)

    Email forwarders for departmental scaling (if necessary)

    Documented and tracked backup and archival strategy for hard and soft files

    IT in place for ease and cyber security protection.

    Phone calls recorded

    Emails saved

    Marketing Systems

    Creating a marketing plan

    Designing and producing promotional materials

    Developing general leads and prospects

    Creating an advertising plan

    Creating a public relations plan

    Creating a direct mail plan

    Developing and maintaining a CRM (for leads, prospects, clients)

    Developing and maintaining a website

    Creating and implementing a social media strategy

    Analyzing and tracking sales metrics (CRM)

    Referral rewards systems

    Designing and sending SMS / Email strategy

    Financial Systems

    Billing/invoicing customers

    Receiving Payments and issuing receipts

    Method, policy for starting the collection process for delinquent receivables.

    Purchasing policies, procedures, and approvals.

    Petty Cash

    Managing the accounting process with daily, weekly, monthly, quarterly, and annual reports

    Managing cash with future borrowing needs secured and available

    Budgeting and forecasting (understanding rations for success)

    Reporting and paying federal and provincial/state or other taxes

    Planning for federal and provincial/state or other taxes

    Paying employees, contractors, and payroll taxes

    Sending client to collections of needed

    Keeping up with chemicals (if applicable)

    Human Resources System

    Recruiting new employees

    Recruiting new contractors

    Interviewing potential employees

    Interviewing potential contractors

    Hiring procedures and policies (Ie. What makes a good employee/contractor)

    Employee agreements

    Contractor agreements

    Payroll process, benefit plans, health and welfare trust

    Other benefits documented/ performance incentive’s

    Performance management/development systems (performance reviews, disciplinary policies and procedures, etc.

    Are you incorporated?

    What electric are you IE

    General Corporate Systems

    Negotiating, drafting, and executing contracts

    Developing and protecting intellectual property

    Managing licensing and insurance needs and coverage

    Managing and storing corporate records

    Maintaining investor/shareholder relations

    Planning and managing growth

    Facilities Management Systems

    Maintaining design telephone and electrical systems

    Planning permits and fees


    Facility security and emergency preplanning

    Do you sell, develop and /or manufacture physical and/or information products?
    Not sure? Physical products include things like T-shirts, furniture, cars - anything that has to be physically manufactured and/or shipped.

    Information products include things like books, eBooks, online courses, DVD courses, etc. Basically, any product that is designed to convey your information or expertise on a topic.

    Do you sell/provide knowledge-based Services?

    Answer yes if your business involves charging for information and or hands-on services such as Swimming pool services, contractor, lawn services, handy man, fitness training, massage, naturopathy, seminars, bookkeeping or any other professional services.

    What are the key challenges you would like help to address?

    What are the key changes you would like to see in yourself, your life and / or your work?

    Why have you specifically decided to reach out to Integrity consultations for help?

    What budget do you have allocated for coaching and how much time are you willing to spend working on this?

    Have you started or established business credit under the Business / LLC?

    Do you have good personal credit?