1. Your Name (required)

2. Your company Name (required)

2a Your Email (required)

3. In 250 words, describe how the past year of your business went?

4. In comparison to the beginning of the year, how satisfied are you in your business right now?
Extremely satisfiedSatisfiedIndifferentUnsatisfiedExtremely unsatisfied

5. In comparison to the beginning of the year, how satisfied are you with your work/life balance?
Extremely satisfiedSatisfiedIndifferentUnsatisfiedExtremely unsatisfied

6. From your list of goals set at the beginning of the year:
6a. What have you successfully achieved?

6b. Did you stay on track with your goals?

6c. What haven’t you completed from your list of goals?

6c-i. Without judgement, why do you think that is? (Time, other priorities, change of direction, etc.)

6c-ii. Knowing that these haven’t been completed, how does that make you feel?
GreatGoodIndifferentBadAwful

7. How has your annual financial goal ended in comparison to last year? (if applicable)
ImprovedSameLowered

8. What worked for you in your business this past year?

9. What didn’t work for you in your business this past year?

10. What would you have liked to do differently this past year?

11. What does a day in your business look like now in comparison to the beginning of the year?

12. How has your business improved in the past year?

13. How have you improved in the past year?

14. What new wisdom have you gained about yourself and your business this past year?

15. Share a clear change you’ve witnessed unfold in you and your business since we’ve started this journey 12 months ago.

16. How satisfied were you with us working together this past year?
Extremely satisfiedSatisfiedIndifferentUnsatisfiedExtremely unsatisfied

17. What worked from us working together?

18. What didn’t work from us working together?

19. What could we have done differently this past year on this journey together?

20. How satisfied were you with the organization of this package?
Extremely satisfiedSatisfiedIndifferentUnsatisfiedExtremely unsatisfied

21. How would you rate the online calls setup?
ExcellentGoodBadAwful

Please add additional comments.

22. How would you rate the length of our monthly sessions?
Too longToo shortJust right

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23.What would you have liked to experience more of from this package?

24. What would you have like to experience less of from this package?

25.What was your favorite part of this past year?

26. Overall, how would you rate the value you received for the price you paid?
ExcellentVery goodGoodPoorVery poor

Please add additional comments.

27. How likely are you to invest in this package again?
Very likelyLikelyUnlikelyUndecided

28. What is the next step on your journey?

29. How can we help you moving forward?
Continue for another yearSchedule appointments on an as need basisWork on my own and come back when I’m ready

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30. I have read and agree to all the policies, terms and conditions set out by this contract agreement.
YesNo

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