Sam Miller Intake Form

Client's Name *

First

Last

Email *

Full Address *

Address Line 1

Address Line 2

City

State

Zip Code

What are the biggest obstacles/frustrations that you are facing in your business right now? *

These obstacles really help me understand what you hope to overcome by working with me AND how I can help you overcome these obstacles.

In one or two sentences, why did you decide to work with me specifically? *

This helps me understand what about me/my approach stood out to you AND I love to use this as an IG story share.

Do I have you permission to share the above answer on social media? *

Of course!
I'd prefer if you didn't

Do you currently have a website? *

Yes
No

What is the URL?

ex. www.darrenpeel.com

What is your current Domain Host?

(ex. GoDaddy, Bluehost, etc.)

Which Social Media platforms would you like to link to in your site? *

Please take a minute to download LastPass AND share all necessary login credentials (username and passwords) with me at me@darrenpeel.com *

Social Media Logins and Passwords
Domain Host Login and Password (if you have purchased a Domain)
Current Website Login and Password (if applicable)
Any Other Softwares (Email Software, Stripe/Paypal, etc.)

This simple step is imperative and saves us a ton of time (and back and forth) in the future.

Now For The Contents Of The Site...

If you could define ONE purpose for your site, what would it be? *

ex. Get visitors to fill out an application to work with me

What title would you like for your website? *

ex. Beyond Gym Selfies, Evolve Health Coaching, Darren Peel's Site

Do you currently have a logo that you would like to use? *

Yes
No

Please upload your logo.

Click or drag a file to this area to upload.

Transparent .png or .svg files preferred

Please upload your logo (2) (Optional)

Click or drag a file to this area to upload.

Transparent .png or .svg files preferred

Please upload your logo (3) (Optional)

Click or drag a file to this area to upload.

Transparent .png or .svg files preferred

Do you have a current color pallet that you would like to use? *

Yep, I can upload a file/image with the color palette
Yes, I can describe the colors I want
Nope.

Please upload a file including the color palette here

Click or drag a file to this area to upload.

Please upload a file that contains your colors (ie. .pdf or .png file) or upload a Brand Style Guide here if you have one.

Please describe the colors you want

If you were to pin-point one main purpose of the site, what would it be? *

ex. Get prospects to submit an application, display my personal brand to establish myself as an authority figure, get visitors to purchase my service

First impressions are paramount... How should visitors describe your new site? (ex. modern, elegant, user friendly, bold, corporate, fun, forward thinking, innovative, bright, calming, elegant, clean, minimal, etc.) *

Please list any competitor's website or websites that you like so that we better understand the style/feel/look you like. *

What are some of your brand values *

What tone would you like for your brand and site (select all that apply) *

What pages/features would you like your website to have? *

If other, please describe the additional page(s) you would like.

Please list any other softwares you are currently using

ex. Mailchimp, Leadpages, ClickFunnels, Typeform, Calendly, etc. (Please ensure login credentials are shared in LastPass as well)

I get really excited seeing sites come together... Is it okay with you that I share the progress of your site on social media?

Of freaking course!
Sure but I won't re-share to keep in on the DL
I'd prefer we keep it a secret till lauch

Is there anything else that you think we should know before designing your site? Any special features, sections, or integrations that we have not addressed that you would like to see included in your site?

Complete Your Intake Form

Now For The Contents Of The Site...