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:

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.

I am meeting my agency growth goals.

I am meeting my agency income goals.

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.

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.

I am happy with the performance of my team.

My staff is motivated to help me reach my goals.

My employees would say they are paid what they are worth.

Life Balance and Relationships

My agency helps me provide good balance between my personal and business life.

I am optimistic about my future.

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.

My company provides competitive rates.

My company provides great training for agents.

My company has incentive programs that motivate me.

My company provides coaching throughout my career.

My company provides systems that help me run my business.

Corporate executives truly care about the agency force and work hard to improve services.

My company commission rates are competitive compared to other insurers.

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