What is your email? *

What is your name? *

What's your company and industry? *

What is your position? *

What is your company's website? *

What are your social media accounts? (Paste their links below) *

Have you ever been featured on a national broadcast or media outlet? *

Yes

Not yet

If yes, where?

Have you been quoted or profiled in a print or online publication? *

Yes

Not yet

If yes, where?

Have you appeared in any local or industry-specific publications? *

Yes

Not yet

If yes, where?

Have you ranked on a best-seller list, award, or notable roundup? *

Yes

Not yet

If yes, where?

Do you have long-form content, interviews, or features online? *

Yes

Not yet

If yes, please share below.

Have you been invited by others to speak, teach, or contribute? *

Yes

Not yet

If yes, where?

Do you regularly appear on media, podcasts, or in guest content? *

Yes

Not yet

What are your other visibility highlights? *

In 6 months, what kind of visibility would feel like momentum for you? *

In 1 year, how would you want your brand to be perceived by your market? *

In 5 years, what lasting reputation or legacy do you want to establish? *

What is the typical value of a new client or sale for your business? *

Under $1,000

$1,000 - $5,000

$5,000 - $20,000

$20,000+

Has your offer been proven with real client results or sales? *

Yes

Not yet

Do you have a working conversion path (calendar, funnel, or sales system)? *

Yes

Not yet

Are you able to clearly describe your ideal client or audience? *

Yes

No

Briefly describe them below.

Are you actively seeking qualified leads, brand trust, or visibility opportunities? *

Yes

No

What is your current annual revenue? *

Under $100K

$100K–$500K

$500K–$1M

$1M–$5M

Over $5M

Do you have a story, mission, or differentiator that sets you apart? *

Yes

No

If yes, you can share more below.

Are you focused on long-term brand equity (vs. short-term metrics)? *

Yes

No

Are you open to being featured or interviewed publicly (camera/audio)? *

Yes

No

Are you open to feedback that strengthens your message and delivery? *

Yes

No

Do you show up reliably for appointments and team collaboration? *

Yes

No

Are you ready to follow a proven visibility system? *

Yes

No

Are you building legacy - not just chasing audience numbers? *

Yes

No

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