Marketing Questionnaire


FIRST NAME:	LAST NAME:

TELEPHONE:	E-MAIL:

FIRM NAME:	CELL PHONE:

ADDRESS:	CITY, STATE, ZIP:


PRACTICE DESCRIPTION:

DESCRIBE YOUR CLIENTS:

DESCRIBE YOUR REFERRAL SOURCES:

ORGANIZATIONS IN WHICH YOU ARE INVOLVED:

OTHER INTERESTS (i.e., hobbies, sports, etc.):

IS YOUR CONTACT DATABASE UP TO DATE?:	DO YOU HAVE SYSTEMS FOR FOLLOWING UP?:
YES	YES

PAST MARKETING ACTIVITIES (check all that apply):
ARTICLES SPEECHES SEMINARS NEWSLETTERS BROCHURES BOOKS
SOCIALIZING RADIO TELEVISION ADVERTISING ORGANIZATIONS
SOCIAL NETWORKING BLOGS WEBCASTS PODCASTS UPDATES OTHER

IF "OTHER" PLEASE DESCRIBE


MARKETING GOALS:


MARKETING OBSTACLES: