Your Practice
(Page 1 of 6)
What best describes your current career stage?
*
I’m experienced but can’t break through my current “income ceiling”
I’m producing but stuck at a plateau
I’m building my career but struggling to get traction
How many years have you been working as a financial advisor or insurance agent?
*
Less than 2
2–5
6–10
11–15
16+
I'm not in the industry
What’s your primary focus?
*
Life insurance
Annuities
Investments
All of the above
common.other_option
What’s your approximate annual income?
*
Under $50k
$50k - $99k
$100k - $149k
$150k - $249k
$250k - $349k
$350k+
What’s your 12-month income goal?
*
$100k
$150k - $249k
$250k - $499k
$500k - $1M
$1M+
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Your Sales Today
(Page 2 of 6)
How important is it for you to improve your closing rate in the next 90 days?
*
Extremely important
Very important
Somewhat important
Not important
Which of the following happens most often in your sales conversations?
*
Prospects ghost me
Endless follow-up cycles
They say “let me think about it”
They object on price
They don’t see value
They freeze and delay decisions
common.other_option
When it comes to closing new clients, what is your biggest challenge right now?
*
How often do you feel frustration or anxiety before or after client meetings?
*
Always
Often
Sometimes
Rarely
If you could fix ONE thing in your sales process today, what would it be?
What’s Holding You Back
(Page 3 of 6)
Which of these internal struggles do you relate to most right now?
*
I feel like I should already be further along
I compare myself to peers and feel behind
I’m worried I’m running out of time
I’m good technically but sales feel inconsistent
I’m afraid I’ll never “make it” in this industry
I’m tired of trying things that don’t work
Finish the sentence: “I’m stuck because…”
*
What have you already tried that didn’t work the way you expected?
*
More scripts
More certifications
More leads
More training programs
Coaching/mentorship
Changing prospecting strategies
common.other_option
Your Goals
(Page 4 of 6)
What outcome would transform your business the fastest?
*
A higher closing rate
Consistent predictable results
Fewer objections and easier conversations
Working with higher-net-worth clients
Shorter sales cycles (1–2 meetings)
Becoming a respected consultant not a salesperson
If you found a proven framework that could 3X your closing rate, how soon would you apply it?
*
Immediately
Within 30 days
Within 90 days
Not sure
If someone could help you with ONE thing, it would be…
*
Finish the sentence: “What I really want is…”
*
Your Why
(Page 5 of 6)
Why did you choose this career in the first place?
*
Who are you doing all of this for?
*
Myself
My spouse/partner
My kids
My parents
My future
common.other_option
Do you have children?
*
Yes — 1
Yes — 2
Yes — 3 or more
Not yet
No
What is your biggest responsibility outside of work? (family, kids, finances, aging parents, bills, etc.)
If you could change ONE thing about your life outside of work, what would it be?
*
About You
(Page 6 of 6)
First Name
*
Last Name
Email
*
Phone
*
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