Full Name
Biz Partner
Your title
How long in business
Company
Address
Phone
*
Email
*
Answer these questions with as much detail as possible.
What is your big “Why?” (Why you do what you do. What drives you?
What are the biggest challenges you are currently facing in your business?
What are the 3 goals you want to achieve over the next year?
What are your current billable hours on a weekly basis?
Do you participate in the marketing for your business?
Yes
No
If yes, how many?
Full-time
Part-time
How many hours per week do YOU spend on marketing?
What is your background? How did you get into this business?
Is your business:
Private Duty (non-medical)
Home Health (Medical)
Hospice
What is your revenue target for this year?
Do you own/manage any other businesses?
Yes
No
If yes, please explain:
In the following section, rate what you currently are experiencing in each area, on a scale of 1-10, and explain why.
Stress
1
2
3
4
5
6
7
8
9
10
No elements found. Consider changing the search query.
List is empty.
Why?
Freedom/Time with family
1
2
3
4
5
6
7
8
9
10
No elements found. Consider changing the search query.
List is empty.
Why?
Hitting your revenue goals
1
2
3
4
5
6
7
8
9
10
No elements found. Consider changing the search query.
List is empty.
Why?
Getting referrals
1
2
3
4
5
6
7
8
9
10
No elements found. Consider changing the search query.
List is empty.
Why?
Converting referrals to clients
1
2
3
4
5
6
7
8
9
10
No elements found. Consider changing the search query.
List is empty.
Why?
Personal finances
1
2
3
4
5
6
7
8
9
10
No elements found. Consider changing the search query.
List is empty.
Why?
What is your marketing budget and plan for this year?
What is the one thing you can add to your business that will bring you success?
What are your strengths?
What are your weaknesses?
What made you decide to contact Hurricane Marketing Enterprises? What is your ideal outcome?
How can Hurricane Marketing Enterprises help you?
Please summarize why you want to be a member of the Home Care Elite Academy. Why are you a good candidate?
List 3 references we can contact. (Name, relation to you, email address, phone number)