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Business Name*

First Name*

Last Name*

Phone Number*

Website/URL

Email*

Address

Que1. What made you decide to become an entrepreneur?*

Que2. Did you start,inherit or purchase this business?*

Que3. Are you satisfied with your experience as a small business owner?* Yes No

Que4. If you are not satisfied - why?

Que5. Do you have a good balance between your business,work,personal life,health and fun?*

Almost Always Frequently Infrequently Seldom or Never

Que6. Do you have a clear picture of what your vision and values are?*

Almost Always Frequently Infrequently Seldom or Never

Que7. Do you work more hours than anyone else in the business?*

Almost Always Frequently Infrequently Seldom or Never

Que8. Do you use a time management system?*

Almost Always Frequently Infrequently Seldom or Never

Que 9. In a perfect world, your business would generate:*

1. sales of $

2. Gross Profits of $

3. Net Profits of $

4. Spend Your Days Doing

Que10. Your vision for your business is to?:*

Sell It Franchise It Replicate It Use It as An Income Source Stay Involved Doing the Strategic Work Other

Que11. When would you like to have your vision complete?

1. 2. 3.

Que12. Is there anything else we should know about your vision that would help us fine tune a course of action?

1. 2. 3.

Que13. List 3 key issues or challenges that are blocking you from achieving your vision:*

1. 2. 3.