Client Intake Form

Contact Information

First name

Last name

Preferred Name (if different)

Email

Phone

Birthday

Month

Day

Year

Address

Website (if applicable)

List all your social media accounts

Professional Snapshot

If not an NP, please place current role

Are you currently:

Employed in a clinical setting

Running your own practice or business

In the process of starting a business

Other

If other, describe

If a business owner, briefly describe your business

Your Goals

What are you interested about in this program?

I want to build a professional brand I’m proud of

I want to increase my visibility as a leader/speaker

I want to grow my business through branding and strategy

I want to attract more aligned clients, patients, or opportunities

I need help getting clear on my direction and message

What are your top 2–3 goals for the next 90 days?

Your Brand or Business

How would you describe your current personal brand or business visibility?

I’m just getting started

I have some pieces in place, but it’s not consistent

I have an established presence, but I want to refine and expand it

Other

If other, describe

Do you have any of the following brand assets? (Check all that apply)

A written professional or speaker bio

A one-pager or speaker/business sheet

A professional headshot

A content plan or posting strategy

Testimonials or reviews

None yet — and that’s okay!

If other, list

Support & Expectations

What kind of support or accountability helps you stay on track?

Are there any barriers you’ve experienced when trying to build your brand or business before?

Just for April

What’s one thing you really want me to know about you, your journey, or your goals?

Is there anything that would make this experience feel especially supportive or meaningful to you?

April J. Odom

Please complete this intake form and then book a date on my calendar

Client Intake Form