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First name

Last name

Position

Briefly describe your business and the products or services you offer:

How long has your business been in operation?

Less than 1 year

1–3 years

3-5 years

5+ years

How many employees or team members are currently part of your organization?

1-5

6–15

16–50

51+

What are your current annual revenues or revenue goals?

What are your top 3 business challenges right now?

What areas of your business would you most like Dr. Bailey’s guidance in? (Select all that apply)

Leadership Development

Scaling & Growth Strategy

Team Building & Culture

Financial Clarity & Systems

Work-Life Balance

Branding & Visibility

Operational Efficiency

Personal Mindset & Confidence

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

How would you describe your leadership style?

What’s one thing you believe is holding you or your business back from its full potential?

What inspires you most about your work or mission?

How do you define success — professionally and personally?

What do you hope to gain from your coaching experience with Dr. Bailey?

Are there any sensitive topics or personal challenges you’d like Dr. Bailey to be aware of prior to your sessions?

What’s your preferred communication style?

Direct & To the Point

Encouraging & Motivational

Analytical & Data-Driven

Creative & Vision-Oriented

Preferred session days/times (M–F between 9 AM – 4 PM):

Best contact number and email for scheduling updates:

BUSINESS COACHING INTAKE FORM

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