Intake Questionnaire…Let’s Get Started

Please take some time to complete the questionnaire below at least 48 hours PRIOR to your schedule initial session with Adeea Rogers. This is the only time you will need to complete this information. Before getting started, please take a few minutes to read the following:

  1. Do not allow these questions to intimidate or overwhelm you. They are designed to spur your thoughts before our session and to help give me some insight into where you are currently
  2. Give yourself some uninterrupted time to complete the questionnaire. If you’d like you can answer the questions in a Word document and paste them in when you’re done.
  3. It is perfectly ok to not know the answers to some of these questions. After all, that is part of the reason we’re working together.
  4. There are no wrong or right answers, just speak from your heart. Truth and authenticity will ensure that you get the most from our time together.
  5. I keep this information under the strictest confidence. I will NEVER share anything we discuss or work on with others.

I am thrilled to work with you and can’t wait to get started!



    First and Last Name (required)

    Business, Blog, Brand, or Organization Name

    Type of Business

    Your Email (required)

    Mailing Address (required)

    Phone Number (required)

    If you completed the Myers-Briggs test, list your personality type.


    Facebook Page

    Twitter @

    Instagram @

    Periscope @


    Please list up to 3 topics, causes, or communities about which you are passionate.

    Please list up to 3 types of people or communities that you desire to help or serve.

    Do you feel you know what your life's purpose is (why you do what you are passionate about)?

    If you know what your life's purpose is, please discuss it below.

    Based on what you love and who you want to serve, what is your B.H.A.G.? Your Big, Hairy, Audacious Goal?

    Why did you start or why do you want to start this business, brand, or endeavor?

    What are the current challenge(s) in starting, maintaining or growing your endeavor?

    How do you currently market your endeavor(s)?
    Word of MouthDirect MailingInstagramPeriscopeTwitterEmailNewspaper and Magazine AdsRadioTelevisionAffiliate Marketing

    Do you have an email distribution list?

    If so, what email list service do you use?
    Constant ContactInfusionSoftMail ChimpAWeberGetResponseGetMimiOther

    Describe the IDEAL person who would support your endeavor.

    Who are your competitors? Be as specific as possible and list websites if you know them.

    What makes you and what you offer different and unique?

    Who inspires you in life and business?

    List a few of your favorite things (books, magazines, podcast, TV shows, websites, causes, etc.).

    What was the last non-fiction book you read related to your industry, business, marketing, etc.

    Why are you interested in working with me?

    What are up to 3 things you'd like to accomplish in working together?

    How did you hear about me?

    Is there anything else you'd like to share with me?


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