New Client Intake Form

Business Name*

Business Address*

Street Address City State / Province / Region ZIP / Postal Code

Main Business Phone*

Primary Contact*

Primary Contact Phone*

Primary Contact Email*

Company Website URL*

What services are being purchased?

Select All
Review Revolution
GMB setup and optimization
GMB Management
Directory Listing Service

GMB/Listing Information

Does The Business Have a Google Business Listing Yet?

Yes
No
Unsure

Has The Listing Been Verified/Claimed Yet?

Yes
No
Waiting on Postcard

Do you want customers to see your address on google?

Yes
No

Business Description

What they do and who they serve? Anything else we want the public to know?

Top 10 Business Categories

List any other social URL's

ie: LinkedIn, Twitter, Pinterest, Facebook, Instagram, Tiktok, Youtube

Complete Business Hours and Special Holiday Hours

List service areas in order of importance

Is the business veteran owned?

Yes
No

Is the business women owned?

Yes
No

Is the business wheel chair accessible?

Yes
No

Is/are the bathroom(s) Unisex?

Yes
No

GMB/Listing Special Notes and Questions

Review Collection Information

Where would you like customers to leave reviews?*

Google
Facebook
Yelp
Other

What other review sites should be included?

List all URL's where reviews will be sent to:

Email address for survey responses*

Email address if a customer wants to contact management*

Phone number if a customer wants to reach out to you about their experience*

Does the client have software with automatic email or text capability?*

Yes
No

What is the software that will be used?

How will feedback requests be sent?*

Email
Text
Both Email and Text

Review Revolution Special Notes

Client's Logo

Drop files here or

Landing Page

Only fill out fields that require changes. Leave a field blank if no changes are required.

Tell it to us straight!

How likely are you to recommend (company name) to friends and family?

Low Funnel (0-5 rating)

Only fill out fields that require changes. Leave a field blank if no changes are required.

We are sorry that your experience did not go well. Which area(s) need improvement?

(Quality of work) (Customer Service) (Timeliness) (Other)

What could have been done differently to improve your experience?

We would like the opportunity to try and make things right. Please enter your contact information below so we can reach out to you.

Low Funnel Special Notes

Mid Funnel (6-8 Rating)

Only fill out fields that require changes.

What could we have done differently to make your experience a 10?

Would you like us to reach out to you?

(Yes) (No)

Mid Funnel Special Notes

Survey Confirmation

This is what the customer sees after they click submit on a 0-8 rating.

Thank you for taking the time to help us learn to serve you better. Let us know if there is anything else we can help you with. (Business Phone)(Management Email)

High Funnel (9-10 Rating)

Only fill out fields that require changes.

We are glad that you were pleased with your experience. Are you able to help us out by leaving a google review? Pretty Please...

(Sure!) (No, thanks.)

Thank you very much for supporting us! Click on the link and it will take you there directly.

High Funnel Special Notes

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First Choice
Second Choice
Third Choice