C L I E N T Q U E S T I O N N A I R E

CLIENT QUESTIONNAIRE

The purpose of this questionnaire is to acquire a basic understanding of the need for service. The knowledge and information shared from this questionnaire will be used solely for the purpose of providing the specific services requested and constitutes an intent to collaborate and provide consultative support. This document is not all encompassing and there may be additional changes or task requirements by both client and provider. This is not a standalone form and should be accompanied by a virtual or in-person meeting(s) no later than two weeks prior to the event start at which all final changes will be confirmed.

An (*) on any question designates a required field.

Write N/A if the question does not apply.

Company Name

Organization/Department/Team Name:

Today's Date

Billing Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Organization's Phone Number

POINT OF CONTACT

The Point of Contact (POC) is the primary organization representative responsible for coordinating actions between the client and consultant(s).

POC Name and Position:

POC Email

POC Work Phone

POC Phone (cell preferred)

Preferred Method of Contact

Phone
Email
Text

POC Birthday

SERVICE and EVENT INFORMATION

Event Name

Event Theme and/or Title

Event Date

Event Start Time:

HOUR

MINUTE

AM/PM

Expected Consultant Arrival Time for Event:

HOUR

MINUTE

AM/PM

Event Location

Location: Address, Email, and Phone number

Number of Event Attendees

My attendee count is:

Estimated
Expected
Confirmed or RSVP

Event Purpose/Description - Please include why this event or service is needed. What will it accomplish for you and the team or organization?

Expected Time Committment

(How long will you expect the consultant to deliver services)

1 hour
2 hours
Half Day (4 hours)
Full Day (8 hours)
Multiple Days

Please describe any additional details about your time requirements?

FACILITY, SPACE, and IT SUPPORT

Facilities

(Please describe the selected facility)

Auditorium
Lecture Hall / Classroom
Event Center / Hotel
Conference Room
Outdoor Space
Other (I'll explain below)

Please describe any additional details about your selected facility?

Multi-media Equipment

(Will there be audio-visual equipment and services available)

If yes, what kind of IT support will be provided for the event or service? (i.e. Audio Visual, IT, Admin Coordinator, Virtual Engineer) Please explain?

Open Space for Group Activities:

(Will there be at least a 20' x 20' open space to conduct group exercises)

Which of the following items will be provided by the client organization?

(Please select all that apply)

Travel (This event/service is not local)
Lodging
Parking
Other

Please describe any additional details about your selected items provided by your organization for this event/service?

AUDIENCE, ADDITIONAL INFORMATION, and NEXT STEPS

Please take a moment to describe the audience. Include information that will help your facilitator be more successful. Relevant information may include:

1. The demographic make-up of the group? (i.e., male, female, non-binary, or any other relevant demographic)
2. Any unique careers, interests, or hobbies shared by the group majority?
3. General group likes and/or dislikes about previous facilitators?

Please describe the audience while keeping the above descriptions in mind?

Please let us know what date and time you are available for our next meeting to discuss this event?

Please include any additional information you would like us to know about your event/service expectations?

Please list a Draft Itinerary, Agenda, Run-of-Show, or any additional background documents on the group:

Please select [SEND] below to submit your answers. We look forward to working with you.

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C L I E N T Q U E S T I O N N A I R E

Thank you for contacting us!