BUSINESS GROWTH STRATEGY SESSION Survey

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* 1. Your Contact Information

Client Name: *

Company:

City/Town:

Country:

Email Address:

Phone Number:

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* 2. Age:


18-21	18-21
22-29	22-29
30-39	30-39
40-49	40-49
50-59	50-59
60-64	60-64
65+	65+

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* 3. Marital Satus:


Single	Single
Married	Married
Partnered	Partnered
Seperated	Seperated
Divorced	Divorced
Widowed	Widowed

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* 4. Your Title:

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* 5. Years in Business:


0 -1 Years	0 -1 Years
2 - 4 Years	2 - 4 Years
5 - 7 Years	5 - 7 Years
8 - 19 Years	8 - 19 Years
10 Years +	10 Years +

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* 6. Yearly Business Revenue:


$0 - $50,000	$0 - $50,000
$50,001 - $150,000	$50,001 - $150,000
$150,001 - $250,000	$150,001 - $250,000
$250,001 - $500,000	$250,001 - $500,000
$500,001 - $1,000,000	$500,001 - $1,000,000
$1,000,001 - $3,000,000	$1,000,001 - $3,000,000
$3,000,000+	$3,000,000+

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* 7. Number of Employees:


0-10	0-10
11-25	11-25
26-50	26-50
55-100	55-100
100+	100+

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* 8. Rate yourself on a scale of 1-10 in each of the following areas. 1 being, that you have not made any progress in this area and 10 that you are where you think you should be by this stage in your life?

	1	2	3	4	5	6	7	8	9	10
Emotions	Emotions 1	Emotions 2	Emotions 3	Emotions 4	Emotions 5	Emotions 6	Emotions 7	Emotions 8	Emotions 9	Emotions 10
Relationships	Relationships 1	Relationships 2	Relationships 3	Relationships 4	Relationships 5	Relationships 6	Relationships 7	Relationships 8	Relationships 9	Relationships 10
Health	Health 1	Health 2	Health 3	Health 4	Health 5	Health 6	Health 7	Health 8	Health 9	Health 10
Customer Service	Customer Service 1	Customer Service 2	Customer Service 3	Customer Service 4	Customer Service 5	Customer Service 6	Customer Service 7	Customer Service 8	Customer Service 9	Customer Service 10
Sales	Sales 1	Sales 2	Sales 3	Sales 4	Sales 5	Sales 6	Sales 7	Sales 8	Sales 9	Sales 10
Finances	Finances 1	Finances 2	Finances 3	Finances 4	Finances 5	Finances 6	Finances 7	Finances 8	Finances 9	Finances 10
Marketing	Marketing 1	Marketing 2	Marketing 3	Marketing 4	Marketing 5	Marketing 6	Marketing 7	Marketing 8	Marketing 9	Marketing 10
Time Management	Time Management 1	Time Management 2	Time Management 3	Time Management 4	Time Management 5	Time Management 6	Time Management 7	Time Management 8	Time Management 9	Time Management 10

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* 9. Pick 3 of the above categories that you want to change and or improve. Ask yourself, what goal would need to be achieved in order to take each of these 3 areas to a level “10” experience?

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* 10. What is the PAY OFF for achieving these goals? What will be different in your life or business once you do achieve the goals? What is the upside or the reward for following through on these goals?

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* 11. Why haven't you already achieved these goals? What is the obstacle or challenge keeping you from achieving them?

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* 12. How long has the above obstacle or challenge been keeping you from these goals?

Please click "DONE" below to submit your answers.

As soon as we receive your completed form a member of our
team will reach out to help find a date/time for you to have your
business growth strategy session!

Have a wonderful day!

To your success,
Jairek Robbins