Global Image Group | Needs Assessment Form

Thank you for your interest in Global Image Group.

Please fill out our needs assessment form to receive a proposal.

Fields in BLUE are required.

Personal Information

Name:
First:
Last:
Address:
Street:
City:
State:
Zip:
Phone: i.e.123-456-7890
Email: i.e.name@dom.com
How did you hear about us?
I am:	Male Female
Contact me by:	Telephone Email
Best time to contact me:	AM PM
Specify Time:
Time frame for consultation:
Preferred office location:
Services of Interest
One-on-One Consulting:
Personal Style Analysis	Yes No
Wardrobe and Closet Analysis	Yes No
Personal Shopping	Yes No
Communication Skills	Yes No
Business and Social Etiquette	Yes No
Executive Impact Program	Yes No
Career Strategies and Protocol	Yes No
Dating Strategies and Protocol	Yes No
Lifestyle Management	Yes No
Nutrition and Wellness Consulting	Yes No
Other Please Specify
Seminars and Workshops:
Executive Impact	Yes No
Image	Yes No
Etiquette	Yes No
Communication	Yes No
Consultation or seminar budget:
What are your current challenges?
What do you hope to achieve from a consultation?

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