Client Intake Form

Confidential | Complete before your first session

This form takes 20 to 30 minutes to complete. Answer every question as specifically as you can. Estimates are fine where exact data is not available — say so when you are estimating. Your answers are confidential. They are used only to prepare for your diagnostic session and to make sure we spend your time on the right problems.

Step 1 of 10. Your Organization

10%

1. Your Organization·
2. Your Revenue·
3. Your Costs·
4. Your Gap·
5. Earned Income·
6. Operations·
7. What You Want·
8. Readiness Check·
9. Logistics·
10. Review Your Answers

1. Your Organization

Organization name

Your name and title

City and state

Years in operation

Annual operating budget, current year

Number of full-time staff

Number of part-time staff

Clients or people served per year, approximate

Primary programs (up to 3)

Your answers save automatically on this device as you type.

BSEG Advisory | Confidential