Apply for Your Value Clarity Report — Business Assessment Form

Contact Information

Full Name

Email *

Phone *

Preferred Contact Method *

Email
Phone Call
SMS (Text Message)
Letter (Mail)
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Business Overview

What Industry Best Describes Your Business? *

Home services (plumbing, HVAC, roofing, etc.)

Professional services (marketing, legal, accounting, etc.)

Healthcare or wellness practice

eCommerce with infrastructure

Small-medium scale manufacturing or distribution

What is your current monthly situation? *

Losing money

Breaking even

$10K - $25K / month

$25K - $50K / month

Over $50K / month

What is your current annual revenue? *

Under $500K

$500K - $1M

$1M - $3M

$3,000,000 - $10,000,00

Over $10,000,000

How long have you been in business? *

Less than 1 year

1 – 3 years

3 – 5 years

5+ years

Current Situation & Challenges

What is your biggest business challenge right now? *

The business depends too much on me

Constantly managing the team

Inconsistent sales/marketing

Lack of financial clarity

Unsure what to focus on next

Always solving problems myself

Have you previously invested in business coaching, consulting, or similar programs? *

Yes - it helped!

Yes - it wasn’t a great fit

I’d be open if it was the right fit

Not yet

Goals & Readiness

What are your primary 3 goals for the next 6–12 months? *

Increase profit

Build systems & reduce my involvement

Install or train leadership

Launch recurring revenue

Productize services

Expand into new markets

Prepare for a future exit or sale

Regain control and reduce stress

Do you currently have a team member or manager who could take over day-to-day operations if needed? *

Yes - they’re close to ready

Yes - with the right support/training

Maybe - I’m not sure

No - I’d need to hire externally