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How did you hear about us?

Are you a business owner? .....Yes .....No0

Number of Owners?

1. What was it you read/heard from Michael Gerber that made sense to you as it relates to what you are experiencing in your business?

Systems Organization

More life Other

2. Why now (as opposed to any other time in the history of the business) is it important to take a look at how you are doing business?

Long hours Family Stress

Health Compensation Other

3. Why or how did you start this business?

Entrepreneurial Seizure Family business Job loss

Family Other

4. What has your experience as a small business owner been like?

Very satisfying Somewhat satisfying Frustrating

A nightmare Other

5. Looking back to when you started this business, how close have you come to reaching the vision that you had for the business?

Have reached it Have come close Not reached it

Have given up on reaching it Other

1. Which best describes your business ?

Retail or Wholesale Service Manufacturing

Professional Other

2. Who are your clients ?

Other businesses Individuals

Other

3. What age group do you attract ?

Under 18 18- 30 30-50

50 + Other

4. Where are your clients located ?

Local National

International Other

5. How do you get the majority of your clients ?

Referral Direct Mail Reputation Media Advertising

Telemarketing Yellow pages Other

6. What marketing efforts have you tried?

Direct Mail Media Telemarketing

Yellow pages Other

7. What kind of results are you getting or did you get ?

Excellent Good Fair

Poor Other

8. Do you have a marketing strategy in place for future growth?

Yes No

Other

9. Do you have a marketing budget?

Yes No

Other

1. Is your business a:

Corporation Partnership

Sole proprietorship Other

2. How profitable are you?

Gross Revenue? Net Profits?

Don’t know

3. How would you describe your cash flow?

Excellent Good Fair

Inconsistent Other

4. Are you paying your bills on time?

Yes No Most of the time

Sometimes Other

5. Do you have any long-term debt?

Yes No

Other or comments:

6. If you answered Yes in question # 5 - are you on a structured pay back schedule?

Yes No

Other

7. What are your terms of payment for your clients/customers?

15 days 30 days

60 days Other

8. How are your receivables collections?

Excellent Good Fair

Poor Other

9. What type of financial reports do you generate on a regular basis?

P & L Balance Sheet Projections

Budget None Other

10. How often?

Weekly Monthly Quarterly

Annually Other

1. How many employees do you have?

None 1-10 10-50

50-100 Over 100 Other

2. How many people are in a management position ?

Less than 5 5- 10

More than 10 Other

3. Are you getting the results you want from your people?

Yes Most of the time Sometimes

Almost never Other

4. Do you have documented, published standards for your people ?

Yes No

Some Other

5. Have you created clear accountabilities for your people ?

Yes No

Some Other

6. Do you have a recruiting & hiring system in place ?

Yes No

Other

7. Do you have a documented training system ?

Yes No

Other

8. Have you created an organizational chart defining the functions of your business ?

Yes No

Other

1. List 3 key issues or challenges facing your business.

1.
2.
3.