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Questionnaire template

New Client Intake

Collects a prospective client's referral source, services wanted, provider priorities and current challenge.

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Corporate · Branded. All Corporate templates

Questions in this template

Where You Are Now

  1. Welcome, and thank you for your interest. These questions help us understand your situation so we can suggest the right support for you.

  2. How did you first find out about us?

    Choose one from a list:

    • Web search
    • Social media
    • Referral from someone
    • Advertising
    • Other

  3. Where did you hear about us?

    Condition: Shown when 'Other' was selected

    Open answer

  4. Which of our services are you interested in? Select all that apply.

    Choose any that apply:

    • Consulting
    • Buying a product
    • Technical support
    • Training
    • Something else

  5. What other service are you looking for?

    Condition: Shown when 'Something else' was selected

    Open answer

  6. How satisfied are you with the provider you use today?

    Choose one:

    • Very satisfied
    • Satisfied
    • Neutral
    • Dissatisfied
    • Very dissatisfied
    • I don't currently use a provider

Your Needs and Preferences

  1. When choosing a provider, how important is each of the following to you?

    • Cost
    • Quality
    • Customer service
    • Innovation
    • Reliability

    For each row: choose one:

    • 1 - Not at all important
    • 2
    • 3
    • 4
    • 5 - Extremely important

  2. What challenge would you most like our help with right now?

    Open answer

  3. Who will be involved in deciding on this work? Please list their names and roles.

    Open answer

Working Together

  1. Rank these factors from 1 (most important) to 5 (least important) when choosing a new provider. Use each rank once.

    • Pricing
    • Customer support
    • Range of services
    • Track record with other clients
    • Knowledge of your sector

    For each row: choose one from a list:

    • 1
    • 2
    • 3
    • 4
    • 5

  2. How much do you agree with each statement?

    • I plan to change provider within the next six months
    • I prefer providers that offer support across the whole engagement
    • I would rather have a tailored service than a standard package

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree