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General Intake Form
Average time to Complete: 10 mins
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Client's Name
*
First
Last
Email
*
Phone
Full Address
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Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
What is the primary goal you are hoping to accomplish by working with Darren?
*
These goals really help us understand what you hope to accomplish by working with us!
In one or two sentences, why did you decide to work with Darren specifically?
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This helps Darren understand what about him/his work/his approach stood out to you!
Which one of these declarations resonates the most with you?
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We're going to build you an extraordinary site that LOOKS, FEELS, and OPERATES like a Million Dollar Brand!
We're going to build you a conversion focused site that actually WORKS to grows your brand... not just a pretty picture that collects digital dust!
We're going to build you a professional site that will WOW your prospect AND position you as an authority in your niche!
Do you currently have a website?
*
Yes
No
What is the URL?
ex. www.darrenpeel.com
What is your current Domain Host?
Examples or domain hosts: Google domains, NameCheap, GoDaddy, Bluehost
Please take a minute to log into your DOMAIN host and add me as admin/delegate access to me, darren@extraordinarybrands.io
Done
Let's do this later together
This simple step is imperative and saves us a ton of time (and back and forth) in the future.
Now For The Contents Of Your Site...
If you could define ONE purpose for your site, what would it be?
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ex. Get visitors to fill out an application to work with me
What title would you like for your website?
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ex. Beyond Gym Selfies, Evolve Health Coaching, Darren Peel's Site
Do you currently have a logo that you would like to use?
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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 palette 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?
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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.)
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Please list any competitor's website or websites that you like so that we better understand the style/feel/look you like.
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What are some of your brand values
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Abundance
Accountability
Ambition
Attention to Detail
Balance
Beauty
Bravery
Capability
Change
Commitment
Communication
Compassion
Confidence
Connection
Consistency
Dependability
Discipline
Ease of Use
Education
Empathy
Empowering
Energy
Excellence
Fearlessness
Focus
Freedom
Fun
Gratitude
Growth
Hardwork
Healthy
Impact
Innovation
Inspiration
Integrity
Leadership
Learning
Mindfulness
Motivation
Patience
Personal Development
Positivity
Productivity
Power
Quality
Relationships
Responsibility
Simplicity
Speed
Strength
Success
Support
Trust
Unity
Warmth
What tone would you like for your brand and site (select all that apply)
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Authoritative
Caring
Cheerful
Conservative
Conversational
Casual
Edgy
Enthusiastic
Formal
Friendly
Fun
Humorous
Informative
Playful
Professional
Serious
Smart
Trendy
Upbeat
What pages/features would you like your website to have?
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Home
About Me/Us
Services
Multiple Sales Pages for Programs
Client Application
Email Capture (ex. Newsletter, Lead Magnet)
Separate Landing Page for Lead Magnets
Instagram Feed Displayed
Blog/Articles
Affiliate Ads/Links/Shop
Podcast Page
Speaker Page
Membership Site
eCourse Hosting
Store
Onboarding Process
Testimonial Capture Page
Other
If other, please describe the additional page(s) you would like.
What are your current offers, programs, or Calls-To-Action (CTA's)?
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ex. Apply to work with me 1-on-1, Sign up for my newsletter, Join my group coaching program, Download my free guide, Book a free strategy call, etc.
If you have an application you are currently using for prospects, please provide the link(s) here
*
ex. Google Forms, TypeForm, etc
Please list any other softwares you are currently using that we may need to integrate with the site
ex. Mailchimp, Leadpages, ClickFunnels, Typeform, Calendly, etc.
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
My business lives and breathes off of referrals! Once we build an extraordinary site that you absolutely love... would you be open to reaching out to your network for possible referrals?
Of course!
I'd rather not say
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?
Submit