Business Assessment Questionnaire

Name*
First Last
Your Member Number:
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Your Reference ID:
If referred to us from one of our Certified Coaches or Affiliates, please enter the provided Reference ID here.
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Email*
How did you find out about us?
Select all of the reasons you are interested in business coaching:
- Increase SAles
- Help Train Staff
- Develop Agency Systems
- Improve Training Systems
- Incorporate Agency Management System
- Recruiting Systems
- Staff Development and Motivation
- Lead Generation
- Better Expense Management
- Find More Balance in My Life
- Improve Time Management System
- Personal Motivation
- Totally Rebuild Agency
Have you ever hired a business coach before?
- No
- Yes
Agency Goals and Performance
I have a clear picture of what I want my agency to look like in the future.
Strongly disagree Disagree Neutral Agree Strongly agree
I am meeting my agency growth goals.
Strongly disagree Disagree Neutral Agree Strongly agree
I am meeting my agency income goals.
Strongly disagree Disagree Neutral Agree Strongly agree
Identify your biggest frustration in your agency as it stands now.
Be detailed here. Only your business coach will see your confidential remarks.
If there are specific systems you know about and want to incorporate into your agency, identify them here:
- Agency Interview and Lead Generation System
- Agent Email Marketing Systems
- Agent Recruiting System
- Agency Website and Branding
- Business Coaching
- Other
Select the documents that you have already created for your business as it stands now:
Select those in which you are completely satisfied and do not need to improve.
- Working Business Plan
- Marketing Strategy
- Organizational Chart
- Budget Plan
- Employee Agreements
- Incentive Program
- Agency Annual Goals
- Agency Monthly Goals
- Agency Daily Goals
- Staff Accountability Measurement
- Clear Brand Image
- Custom Logo and Slogan
- Business Facebook Page
- LinkedIn Profile Fully Developed
- Company Website
- Documented Staff Training System
- Client Retention Program
Staffing and Teamwork
Total number of full-time staff not including yourself.
Total number of part-time staff not including yourself.
Total number of Referral Partners not including yourself.
Do you hold regular staff meetings?
- No
- Yes
- N/A
My employees know what my goals and vision of the agency would be.
Strongly disagree Disagree Neutral Agree Strongly agree
I am happy with the performance of my team.
Strongly disagree Disagree Neutral Agree Strongly agree
My staff is motivated to help me reach my goals.
Strongly disagree Disagree Neutral Agree Strongly agree
My employees would say they are paid what they are worth.
Strongly disagree Disagree Neutral Agree Strongly agree
Life Balance and Relationships
My agency helps me provide good balance between my personal and business life.
Strongly disagree Disagree Neutral Agree Strongly agree
I am optimistic about my future.
Strongly disagree Disagree Neutral Agree Strongly agree
How has your stress affected your attitude.
How is your business affecting your personal life?
The Company You Represent
What primary carriers do you represent?
My company is among the top to provide service and support to the agency force.
Strongly disagree Disagree Neutral Agree Strongly agree
My company provides competitive rates.
Strongly disagree Disagree Neutral Agree Strongly agree
My company provides great training for agents.
Strongly disagree Disagree Neutral Agree Strongly agree
My company has incentive programs that motivate me.
Strongly disagree Disagree Neutral Agree Strongly agree
My company provides coaching throughout my career.
Strongly disagree Disagree Neutral Agree Strongly agree
My company provides systems that help me run my business.
Strongly disagree Disagree Neutral Agree Strongly agree
Corporate executives truly care about the agency force and work hard to improve services.
Strongly disagree Disagree Neutral Agree Strongly agree
My company commission rates are competitive compared to other insurers.
Strongly disagree Disagree Neutral Agree Strongly agree
If there is anything else you would like us to know about your agency, please include it here.
If you would like this report to go to your business coach or manager, include his or her email below.
Would you like to sign up for our monthly newsletter?
- No
- Yes
After submission, do you mind answering a quick survey about the State of the Business Owner?
FREE GIFT: This survey will only take a few minutes, is extremely confidential and will help us gather research to report to insurers about the affect training and support can have on insurance agents who rely on them to provide exceptional service. Your name will not be included in our report, but your answers can help shape training programs and coaching offered in the future. And as a gift, we will give you a FREE eBook Summary of Jeff Hastings book, "So You Want to be an Insurance Agent" for your perusal.

Business Assessment Questionnaire

Business Assessment Questionnaire

Agency Goals and Performance

Staffing and Teamwork

Life Balance and Relationships

The Company You Represent

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