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Accoutants
Acupuncturists
Attorneys
Automotive
Career Counseling
Chiropractors
Copulas Massage
Counselors
Family Counseling
Family Law Attorneys
Financial Planners
Lawyers
Marketing Agencies
Massage
Notary
Occupational Therapy
Physical Therapist
Tax Accountants
Therapists
Web Designers
Wills Attorneys
Marriage Counseling
CPA Firms
Bookkeepers
Divorce Lawyers
Coaching
Business
Nutrition
Writing & Translation
What type of massage would you like?
*
Swedish massage (standard)
Deep tissue massage
Sports massage
Pregnancy massage
Reflexology massage
Hot stone massage
Medical massage
Myofascial release
What is your primary reason for getting a massage?
*
Relaxation / stress relief
Increased flexibility
Pain relief
When was your most recent massage therapy session?
Within the last month
1 - 6 months ago
7 - 12 months ago
Over a year ago
Not applicable
How long would you like the session to be?
*
30 minutes
60 minutes
90 minutes
How many people need the massage?
*
1 person
2 person
Where would you like to receive the massage?
*
At the massage therapist's location
At my home or business location
Pros will typically charge a fee to travel to your location
Do you prefer to have a massage therapist of a certain gender?
*
I have no preference
I would like female massage therapists only
I would like male massage therapists only
How would you like to meet with the massage therapist?
*
I travel to the massage therapist
The massage therapist travels to me
When would you like the massage therapy?
*
I'm flexible
Within a week
As recommended by the pro
On a specific date
Anything else the massage therapist should know? (optional)
Please confirm where you need the massage therapy.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What would you like done?
*
New websites
Major overhaul of my existing website
Minor changes to my website
What type of website do you have / would you like?
*
Personal website
Blog
Social network / community
E-commerce
Business or nonprofit
If there are additional details about your project that the web designer should know, please describe them here. (Optional)
Will you provide the web designer with the content for your site (images, written content, etc.)?
*
I will provide all the content
I will provide most of the content
I will provide some of the content
I would like the designer to create the content for me
How many new pages would you like?
*
1 - 5 pages
6 - 10 pages
11 - 20 pages
21 - 30 pages
31 - 40 pages
41 - 50 pages
More than 50 pages
I don't need any new pages
What is your estimated budget?
*
Over $3,000
$2,500 - $3,000
$2,000 - $2,500
$1,500 - $2,000
$1,000 - $1,500
$500 - $1,000
Not sure yet
What additional services would you like?
*
Mobile design
Develop responsive web design
Mobile-optimized
Search engine optimization
Social media integration
Web hosting
Blogging
E-commerce capabilities (e.g., product photos, credit card processor setup)
To be determined with professional
How would you like to meet with the web designer?
*
I travel to the web designer
The web designer travels to me
Phone or internet (no in-person meeting)
When do you need web design?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the web designer should know? (Optional)
Please confirm where you need the web design.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
Get responses even faster with text alerts. (optional)
What type of therapy?
*
Physical therapy
Orthopedic
Manual therapy
Sports rehabilitation
Occupational therapy
Hand therapy
Fitness and wellness
Which region of your body?
*
Back
Neck
Arms
Leg/Feet
Hips
How old are you?
*
Younger than 18
18 - 22 years old
23 - 30 years old
31 - 40 years old
41 - 50 years old
51 - 60 years old
60 or older
How would you like to meet with the physical therapist?
*
I travel to the physical therapist
The physical therapist travels to me
How often do you need the physical therapy?
*
Once per week
More than once per week
Every two weeks
Monthly
When do you need this service?
*
Weekday mornings
Weekday afternoons
Weekday evenings
Saturday/Sunday
Select all the times that work for you.
Anything else the physical therapist should know?(Optional)
Please confirm where you need the physical therapy.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name
*
First
Last
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Why would you like acupuncture treatment?
*
General pain management
Pain and symptom management from chronic condition (such as arthritis and cancer)
Pain management from accident or specific trauma
Stress
Fatigue
What services would you like in addition to acupuncture, if any? (Optional)
Cupping
Moxibustion
Magnets
Herbal medicine
How old are you?
*
18 - 22 years old
23 - 30 years old
31 - 40 years old
41 - 50 years old
51 - 60 years old
61 or older
How often would you like to meet?
*
Once a week
More than once a week
As recommended by professional
What days are you available to meet?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
(Tip: Offering more availability may help you get more quotes.)
What times are you available to meet?
*
Early morning (before 9am)
Morning (9am - noon)
Early afternoon (noon - 3pm)
Late afternoon (3 - 6pm)
Evening (after 6pm)
(Tip: Offering more availability may help you get more quotes.)
How would you like to meet with the acupuncturist?
*
I travel to the acupuncturist
The acupuncturist travels to me
When do you need acupuncture services?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the acupuncturist should know?(Optional)
Please confirm where you need the acupuncture services.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What are your counseling needs?
*
Improving communication
Dealing with stress or depression
Figuring out life direction
Dealing with a loss
Building confidence and esteem
Resolving trauma
Changing negative habit
Intervention
If you have specific challenges the counselor should know of, please describe them here.(Optional)
Do you have insurance?
*
Yes, my plan covers counseling
Yes, but I'm not sure if my plan covers counseling
No
If you have insurance, please provide the name of your insurance carrier.(Optional)
Do you have a counselor gender preference?
*
No preference
Male
Female
What days are you available to meet?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
(Tip: Offering more availability may help you get more quotes.)
What times are you available to meet?
*
Early morning (before 9am)
Morning (9am - noon)
Early afternoon (noon - 3pm)
Late afternoon (3 - 6pm)
Evening (after 6pm)
(Tip: Offering more availability may help you get more quotes.)
How would you like to meet with the counselor?
*
I travel to the counselor
The counselor travels to me
Online counseling
When do you need counseling?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the counselor should know?(Optional)
Please confirm where you need the counseling.
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name
*
First
Last
Do you have any previous experience working with a therapist or counselor?
*
Yes
No
What kind of counseling?
*
General conflict
Divorce
Domestic violence
Serious illness
Death
I'm not sure
How often would you like counseling?
*
Once a week
Once a month
More than once a month
I'm not sure
Do you have a counselor gender preference?
*
No preference
Male
Female
How would you like to work with the family counselor?
*
I travel to the family counselor
The family counselor travels to me
Online counseling
When do you need family counseling?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the family counselor should know?(Optional)
Please confirm where you need the family therapy.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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How large is your business?
*
Small (fewer than 10 employees)
Medium (10-50 employees)
Large (more than 50 employees)
Not sure
What is the primary type of marketing you are interested in?
*
General
Flyer distribution
Branding services
Custom promotional products
Direct mailing
Product ambassador
Digital (Web / E-Mail)
What type of marketing service(s) would you like?
*
Consulting
Creative services
Analytic services
Operational services
I'm not sure yet
How would you like to meet with the marketer?
*
I travel to the marketer
The marketer travels to me
Phone or internet (no in-person meeting)
When do you need marketing?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the marketing special should know?(Optional)
Please confirm where you need the marketing agency.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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Why would you like a chiropractor treatment?
*
General pain management
Pain and symptom management from chronic condition
Pain management from accident or specific trauma
How old are you?
*
18 - 22 years old
23 - 30 years old
31 - 40 years old
41 - 50 years old
51 - 60 years old
61 or older
How often would you like to meet?
*
Once a week
More than once a week
As recommended by professional
What days are you available to meet?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
(Tip: Offering more availability may help you get more quotes.)
What times are you available to meet?
*
Early morning (before 9am)
Morning (9am - noon)
Early afternoon (noon - 3pm)
Late afternoon (3 - 6pm)
Evening (after 6pm)
(Tip: Offering more availability may help you get more quotes.)
How would you like to meet with the chiropractor?
*
I travel to the chiropractor
The chiropractor travels to me
When do you need chiropractor services?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the chiropractor should know?(Optional)
Please confirm where you need the chiropractor.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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Who is the accounting service for?
*
Individual or sole proprietorship
LLC
Partnership
C-Corp / Corporation
S-Corp
Non-profit
How many employees to you have?
*
1 employee (sole proprietor)
2 - 20 employees
20 - 50 employees
50 - 100 employees
100 - 500 employees
500+ employees
What industry are you in?
*
Sales & marketing
Healthcare
Technology / IT
Manufacturing
Financial services
Education
Retail / consumer goods
Real estate
Construction
Non-profit
What is your annual personal or company income?
*
Less than $100K
$100K - $500K
$500K - $1M
$1M - $5M
$5M - $10M
Greater than $10M
What accounting software do you currently use?
*
QuickBooks
Xero
NolaPro
Sage
I currently don't use any accounting software
Other
What are your primary accounting needs?
*
Balancing books
Preparing tax returns
Managing accounts receivable and payable
Preparing financial statements
How often would you like to receive accounting services?
*
One time
Every year
Weekly
Monthly
Quarterly
Full time
How would you like to meet with the accountant?
*
I travel to the accountant
The accountant travels to me
Phone or internet (no in-person meeting)
When do you need accounting?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the accountant should know?(Optional)
Please confirm where you need the accounting.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What type of tax preparation do you need?
*
Individual tax preparation
Business tax preparation
What best describes your filing status?
*
Single
Married filing jointly
Married filing separately
Head of household
Qualifying widow(er) with dependent child
Are you self-employed?
*
Yes
No
Do any of these itemized deductions apply to you?
*
None
Property, state, and local income taxes
Home mortgage interest
Investment interest expense
Charitable contributions
Medical and dental expenses
(Most individuals do not need to itemize.)
Do any of the following special tax situations apply to you?
*
None
Rental property
Stocks or bonds
Disability
Military service
Foreign income
What is your primary reason for hiring a tax prep professional?
*
I want to save time on my taxes
My taxes are too complex to file myself
I want to see if professional tax prep is in my budget
How would you like to meet with the tax preparer?
*
I travel to the tax preparer
The tax preparer travels to me
Phone or internet (no in-person meeting)
When do you need tax attorney?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the tax preparer should know?(Optional)
Please confirm where you need the tax accounting.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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How comfortable are you with managing your finances?
*
Very comfortable
Somewhat comfortable
Not comfortable at all
What stage in your career are you?
*
Entry-level / Junior
Mid-level
Senior-level / Management
Executive
Approaching retirement
Already retired
What is your annual income?
*
Less than $40,000
$40,000 - $60,000
$60,000 - $80,000
$80,000 - $100,000
$100,000 - $150,000
$150,000 - $250,000
Greater than $250,000
What primary financial planning assistance do you need?
*
General financial planning
Retirement planning
Life insurance review
Investment review
Tax planning
College planning
Trusts or estate planning
Annuities
Mutual funds
Home purchase
Please describe any major financial obligations you have now, or will have within the next five years.(Optional)
How would you like to meet with the financial services agent?
*
I travel to the financial services agent
The financial services agent travels to me
Phone or internet (no in-person meeting)
When do you need financial services and planning?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the financial planner should know?(Optional)
Please confirm where you need the financial services and planning.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name
*
First
Last
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How many signatures need to be notarized?
*
1
2
3
4
5
6-10
More than 10
I'm not sure yet
How would you like to meet with the notary public?
*
I travel to the notary public
The notary public travels to me
When do you need notarization?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the notary should know?(Optional)
Please confirm where you need the notary.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What type of legal issue needs to be addressed?
*
Civil
Family/Divorce
Criminal
Accident/Injury
Corporate
Employment
Bankruptcy
Other
What type of service are you interested in?
*
Consultation
Representation
Other
How would you like to meet with the attorney?
*
I travel to the attorney
The attorney travels to me
Phone or internet (no in-person meeting)
When do you need an attorney?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the attorney should know?(Optional)
Please confirm where you need the attorney.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What type of legal issue needs to be addressed?
*
Civil
Family/Divorce
Criminal
Accident/Injury
Corporate
Employment
Bankruptcy
Other
What type of service are you interested in?
*
Consultation
Representation
Other
How would you like to meet with the lawyer?
*
I travel to the lawyer
The lawyer travels to me
Phone or internet (no in-person meeting)
When do you need an lawyer?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the lawyer should know?(Optional)
Please confirm where you need the lawyer.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What area of family law would you like assistance with?
*
Child custody / child support
Divorce or legal separation
Prenuptial agreement
Domestic violence
Adoption and surrogacy
Other
Who are the family members involved?
*
Self
Husband / Wife (domestic partner)
Parents
Siblings
Children
Grandparents
Extended family
Other
Please describe any additional details the attorney should be aware of.(Optional)
How would you like to meet with the family law attorney?
*
I travel to the family law attorney
The family law attorney travels to me
Phone or internet (no in-person meeting)
When do you need family law attorney?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the family law attorney should know?(Optional)
Please confirm where you need the family law attorney.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What is the primary work needed for the will or estate plan?
*
Wills
Living trusts
Trusts
Powers of attorney
Other
What type of service are you interested in?
*
Consultation
Representation
Other
How would you like to meet with the wills & estate planner?
*
I travel to the wills & estate planner
The wills & estate planner travels to me
When do you need wills and estate planning?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the wills & estate planner should know?(Optional)
Please confirm where you need the wills attorney.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What are your goals for therapy?
*
Managing anxiety or stress
Overcoming an addiction
Resolving specific fear or phobia
Weight loss
Dealing with depression
Improving my life
Other
If you have specific goals for therapy, please describe them here.(Optional)
If you have any challenges the therapist should be aware of, please describe them here.(Optional)
Do you have insurance?
*
Yes, my plan covers therapy
Yes, but I'm not sure if my plan covers therapy
No
Other
Do you have a therapist gender preference?
*
No preference
Male
Female
What days are you available to meet?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
(Tip: Offering more availability may help you get more quotes.)
When are you available to meet?
*
Early morning (before 9am)
Morning (9am - noon)
Early afternoon (noon - 3pm)
Late afternoon (3 - 6pm)
Evening (after 6pm)
(Tip: Offering more availability may help you get more quotes.)
How would you like to meet with the therapist?
*
I travel to the therapist
The therapist travels to me
Online therapy
When do you need therapy?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the therapist should know?(Optional)
Please confirm where you need the therapy.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What type of massage would you like for Person 1?
*
Swedish Massage
Deep Tissue Massage
Sports Massage
Hot Stone Massage
Reflexology
Medical
Other
What type of massage would you like for Person 2?
*
Swedish Massage
Deep Tissue Massage
Sports Massage
Hot Stone Massage
Reflexology
Medical
Other
How long would you like the session to be?
*
60 minutes
90 minutes
Therapist gender preference for person 1
*
Female
Male
No preference
Therapist gender preference for person 2
*
Female
Male
No preference
How would you like to meet with the massage therapist?
*
I travel to the massage therapist
The massage therapist travels to me
When do you need couples massage?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the massage therapist should know?(Optional)
Please confirm where you need the couples massage.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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Where are you in your career?
*
Entry-level
Professional / Mid-career
Management / Executive
In school / Recent graduate
Other
What industry are you in?
*
Sales & marketing
Healthcare
Technology / IT
Manufacturing
Financial services
Education
Retail / consumer goods
Real estate
Construction
Non-profit
Other
What would you like to achieve with your career coach?
*
Find a new job
Explore future career options
Change jobs
Improve leadership skills
Create a healthier work-life balance
Enhance current job
Other
What specific challenges do you feel the coach should be aware of?(Optional)
How frequently would you like to meet with your coach?
*
One time only
Recurring – weekly
Recurring – monthly
As suggested by the coach
Other
When are you available?
*
Weekday mornings
Weekday afternoons
Weekday evenings
Saturday/Sunday
How would you like to meet with the career coach?
*
I travel to the career coach
The career coach travels to me
Phone or internet (no in-person meeting)
Anything else the career coach should know?(Optional)
Please confirm where you need the career coaching.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
Get responses even faster with text alerts.
Which region of your body?
*
Back
Neck
Arms
Legs/feet
Hips
Other
How old are you?
*
Younger than 18
18 - 22 years old
23 - 30 years old
31 - 40 years old
41 - 50 years old
51 - 60 years old
60 or older
How would you like to work with the occupational therapist?
*
I travel to the occupational therapist
The occupational therapist travels to me
When do you need occupational therapy?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the occupational therapists should know?(Optional)
Please confirm where you need the occupational therapy.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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Are you and your partner seeking counseling together?
*
Yes, we are both seeking help
No, but my partner knows I am seeking help
No, my partner does not know I am seeking help
Other
What are your counseling goals?
*
Communicating better
Conflict resolution
Rebuilding trust
More intimacy and passion
Family planning
Other
If you have specific challenges the counselor should know of, please describe them here.(Optional)
Do you have insurance?
*
Yes, my plan covers counseling
Yes, but I'm not sure if my plan covers counseling
No
Other
Do you have a counselor gender preference?
*
No preference
Male
Female
What days are you available to meet?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Tip: Offering more availability may help you get more quotes.
What times are you available to meet?
*
Early morning (before 9am)
Morning (9am - noon)
Early afternoon (noon - 3pm)
Late afternoon (3 - 6pm)
Evening (after 6pm)
Tip: Offering more availability may help you get more quotes.
How would you like to meet with the marriage counselor?
*
I travel to the marriage counselor
The marriage counselor travels to me
Online counseling
When do you need marriage counseling?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the marriage counselor should know?(Optional)
Please confirm where you need the marriage counseling.
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name
*
First
Last
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Who is the accounting service for?
*
Individual or sole proprietorship
Partnership
C-Corp / Corporation
S-Corp
Non-profit
How many employees to you have?
*
1 employee (sole proprietor)
2 - 20 employees
20 - 50 employees
50 - 100 employees
100 - 500 employees
500+ employees
What industry are you in?
*
Sales & marketing
Healthcare
Technology / IT
Manufacturing
Financial services
Education
Retail / consumer goods
Real estate
Construction
Non-profit
Other
What is your annual personal or company income?
*
Less than $100K
$100K - $500K
$500K - $1M
$1M - $5M
$5M - $10M
Greater than $10M
What accounting software do you currently use?
*
Xero
NolaPro
Sage
I currently don't use any accounting software
Other
What are your primary accounting needs?
*
Balancing books
Preparing tax returns
Managing accounts receivable and payable
Preparing financial statements
Other
How often would you like to receive accounting services?
*
One time
Weekly
Monthly
Quarterly
Full time
Other
How would you like to meet with the accountant?
*
I travel to the accountant
The accountant travels to me
Phone or internet (no in-person meeting)
When do you need accounting?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the accountant should know?(Optional)
Please confirm where you need the cpa firm.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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Who is the bookkeeping service for?
*
Individual or sole proprietorship
Partnership
C-Corp / Corporation
S-Corp
Non-profit
How many employees to you have?
*
1 employee (sole proprietor)
2 - 20 employees
20 - 50 employees
50 - 100 employees
100 - 500 employees
500+ employees
What industry are you in?
*
Sales & marketing
Healthcare
Technology / IT
Manufacturing
Financial services
Education
Retail / consumer goods
Real estate
Construction
Non-profit
Other
What is your annual personal or company income?
*
Less than $100K
$100K - $500K
$500K - $1M
$1M - $5M
$5M - $10M
Greater than $10M
What accounting software do you currently use?
*
QuickBooks
Xero
NolaPro
Sage
I currently don't use any accounting software
Other
What are your primary bookkeeping needs?
*
Balancing books
Preparing tax returns
Managing accounts receivable and payable
Preparing financial statements
Other
How often would you like to receive bookkeeping services?
*
One time
Weekly
Monthly
Quarterly
Full time
Other
How would you like to meet with the business tax bookkeeper?
*
I travel to the bookkeeper
The bookkeeper travels to me
Phone or internet (no in-person meeting)
When do you need business tax preparation?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the bookkeeper should know?(Optional)
Please confirm where you need the bookkeeping.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
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What type of divorce issues would you like to be addressed?
*
Divorce
Child-related (custody, support, visitation, etc.)
Alimony / property and asset division
Legal separation
Other
Is this a new case, in process, or an appeal?
*
New motion or petition
Case in process
Appeal
Mediation
Other
What kind of service would you like?
*
Consultation / advice
Representation
Other
Are these issues agreed upon by both parties, or will they be contested?
*
Agreed
Contested
Please enter the zip code in which the case will be / has been filed.
*
ZIP / Postal Code
How would you like to meet with the divorce attorney?
*
I travel to the divorce attorney
The divorce attorney travels to me
Phone or internet (no in-person meeting)
When do you need divorce attorney?
*
I'm flexible
In the next few days
As soon as possible
On one particular date
Anything else the divorce attorney should know?(Optional)
Please confirm where you need the divorce lawyer.
*
ZIP / Postal Code
Where should we send your matches?
*
Please enter your full name.
*
First
Last
Get responses even faster with text alerts.
Which areas of coaching are you interested in?
*
Career
Relationships
Developing positive habits
Dealing with stress
Spirituality
Other
If you have specific goals for your coaching sessions, please describe them here (Optional)
If you have specific challenges you feel the coach should be aware of, please describe them here. (optional)
How frequently would you like to meet with your coach?
*
One time only
Recurring – weekly
Recurring – monthly
As suggested by the coach
Other
What days are you available to meet?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Tip: Offering more availability may help you get more quotes.
What times are you available to meet?
*
Early Morning (before 9am)
Morning (9am - noon)
Early afternoon (noon – 3pm)
Late afternoon (3 – 6pm)
Evening (after 6pm)
Tip: Offering more availability may help you get more quotes.
Do you have a coach gender preference?
*
No preference
Male
Female
How would you like you like to meet with the life coach?
*
I travel to the life coach
The life coach travel to me
Phone or internet (no in-person meeting)
When do you need life coaching?
*
I’m flexible
In the next few days
As soon as possible
On one particular date
Anything else the life coach should know? (Optional)
Please confirm where you need the life coaching.
*
ZIP / Postal Code
Where should we send you the matches?
*
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What would you like your nutritionist to help you with?
*
Weight loss
Gain muscle
Improve sports performance
Manage health conditions (e.g., diabetes, high cholesterol)
Other
How old is the client?
*
Younger than 18
18 – 22 years old
23 - 30 years old
31 – 40 years old
41 – 50 years old
51 – 60 years old
61 – 70 years old
71 or older
Do you currently follow a special diet or nutritional program? If so, please indicate it below. (Optional)
Low Carbohydrate
High Protein
Low Fat
Low Gulten / Gulten-free
No Dairy
Low Sodium
Vegetarian / Vegan
Diabetic
Other
On average, how many home-cooked meals per week do you eat?
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None
Very few meals (1 – 2 meals per week)
Some meals (3 – 7 meals per week)
Almost all meals
On average, how many days per week do you eat breakfast?
*
1 day
2 days
3 days
4 days
5 days
6 days
7 days
On average, how many cups of coffee or soda do you drink per day?
*
Never
1 cup per day
2 – 3 cups per day
4 or more cups per day
On average, how many cups of water do you drink per day?
*
None
1 cup per day
2 – 3 cups per day
4 – 7 cups per day
8 or more cups per day
Please list food allergies your nutritionist should know about, if any (Optional)
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Bank Name
Account Name
Account Number
Sort Number
IBAN
BIC/Swift
Bank Name
Bank Account Name
123-5678-123
345
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CNA768
