Click inside any box to fill out this Revenue Leak Diagnostic Intake Form live.

REVENUE LEAK DIAGNOSTIC INTAKE FORM

This form helps uncover where leads, follow-up, referrals, reviews, retention, and backend revenue may be leaking.

1. Business Basics

Business Name
Type business name here...
Website URL
Type website here...
Industry
Type industry here...
Main Contact Name
Type contact name here...
Email
Type email here...
Phone Number
Type phone number here...

2. Current Customer Acquisition

How do most new customers currently find you?
Google Search
Referrals
Facebook
Instagram
YouTube
Paid Ads
Email Marketing
Repeat Customers
Networking
Other
Approximate Monthly Leads / Customers
Example: 10–25, 25–50, 50–100, 100+
Average Customer Value
Example: $500, $1,500, $10,000...

3. Follow-Up & Backend Systems

Which systems do you currently use?
Email Follow-Up
SMS Follow-Up
CRM
Appointment Reminders
Missed-Call Text-Back
Newsletter
Retargeting Ads
Review Requests
Referral Campaigns
None
Describe your current follow-up process
What happens after someone calls, fills out a form, books, messages, or shows interest?

4. Biggest Business Problems

What feels like your biggest growth bottleneck right now?
Example: not enough leads, poor conversions, weak referrals, inconsistent revenue, low retention, poor follow-up...
Where do you believe money is currently slipping through the cracks?
Type answer here...

5. Business Goals

What would improving your backend systems help you achieve?
More Leads
More Conversions
Better Follow-Up
More Repeat Customers
More Referrals
Better Reviews
Higher Customer Value
Ability To Scale Ads
More Predictable Revenue
Other
Revenue Goal
Example: Add $5,000/month, $10,000/month, $30,000/month...

6. Revenue Leak Scorecard

Lead Capture
__/10
Follow-Up
__/10
Offer Structure
__/10
Referral Systems
__/10
Review Systems
__/10
Retention
__/10
Missed Opportunity
__/10
Backend Monetization
__/10
Ad Readiness
__/10
Conversion Systems
__/10
Total Score
____ /100

7. Helpful Materials / Assets

Materials client can provide
Brochures, offers, pricing sheets, screenshots, ad examples, emails, follow-up examples, sales scripts, customer journey notes, CRM screenshots, or campaign examples.
Links / Notes
Paste links or notes here...

8. Optional Access

Would client provide temporary read-only access?
Facebook Page
Google Business Profile
CRM
Email System
Ad Account
Analytics
Booking System
None Right Now

Final Killer Question

If you could fix ONE revenue leak in your business immediately, what would it be?

Type answer here...