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Cash Flow ICU Diagnostic – Intake Form
Before we begin your diagnostic, help me get a precise picture of your business. These answers allow me to identify the leaks, patterns, and controls needed to stabilize and transform your cash flow.
Business Information
Legal Business Name
*
DBA/Brand Name
*
Business Website
*
Business email address
*
Industry
*
If Other, Please add below
*
Business Structure (e.g. LLC, S-Corp, C-Corp, or Sole Proprietorship)
Years in Business
*
Number of Employees/Contractors
*
Cash Flow Snapshot Average Annual Revenue (last 90 days)
*
Average Annual Expenses
*
Average Annual Expenses
A
Under $10K
B
$10K–$30K
C
$30K–$75K
D
$75K–$150K
E
$150K+
Current Cash on Hand
*
Have you experienced cash-flow shortages in the last 6 months?
*
On a scale of 1–10, how stressful is managing cash flow for you right now?
*
On a scale of 1–10, how stressful is managing cash flow for you right now?
0
1
2
3
4
5
6
7
8
9
10
Systems & Accounting
What Accounting system do you use? (QBO, Xero, Wave, None, Other)
*
Are your books up to date through last month?
*
Are your books up to date through last month?
A
Yes
B
No
C
Unsure
Do you track these regularly? (Check all that apply)
*
Do you track these regularly? (Check all that apply)
Accounts Receivable
Accounts Payable
Sales Tax
Payroll
Owner Draws / Distributions
Loan Payments
Inventory
None of the above
Upload your most recent Profit and Loss and Balance Sheet
*
Click to choose a file or drag here
Size limit: 10 MB
Business Model & Cash Flow Behavior
What are your top 3 revenue streams?
*
What is your biggest cash-flow bottleneck right now? (Examples: slow payers, high overhead, no budgeting system, poor pricing, inconsistent revenue, debt load, etc.)
*
Do you use any forecasting tools today?
*
How quickly would you like to see cash-flow improvement?
*
Decision & Fit
What makes now the right time for a Cash Flow ICU Diagnostic?
*
If your cash flow improved, what would change for your business in the next 6–12 months?
*
Are you willing to implement the controls and recommendations provided?
*
If accepted, are you prepared to invest in the Diagnostic today?
*
Submit
