Coaching Client Intake Form – Prof Bruce

Hi! As you may already know, Bruce Firestone, PhD, is a real estate and business coach focused primarily on growing revenues and business modelling plus helping you find your why, identifying the right pathways forward for you (and avoiding the wrong ones), establishing an entrepreneurialist mindset and then assisting you to stay on course and on track.

Here is a free online ECQ test that tries to measure your pre-disposition to entrepreneurship, https://brucemfirestone.com/quiz/ecq-quiz/… try it to see how well suited you may be to becoming an entrepreneur or intrapreneur.

Note, if you are specifically most interested in real estate, please also complete this form, WHAT INTERESTS YOU MOST IN REAL ESTATE available for download from Dropbox, https://www.dropbox.com/scl/fi/v5cnt2v668ieersup4dqs/What-interests-you-most-in-real-estate-form-Bruce-M-Firestone-PhD.pdf?rlkey=rkel1b74nfvj4e44h6dgu2upf&st=pb2xzayo&dl=0 and return it to bruce@brucemfirestone.com.

Welcome! This intake form helps determine whether you and Prof Bruce are a great fit to work together and how he can best help you grow. Let’s begin by having you complete the following—note you can also complete this form online using Jotform—Apply for coaching with Bruce Firestone, https://form.jotform.com/251555671529060.

👤 Basic Info

1. Full Name: ________________________________________________
2. Email Address: ________________________________________________
3. Cell Number: ______________________________
4. Location (City, Country): ______________________________
5. LinkedIn Profile / Website: ________________________________________________

🚀 About You and Your Business

6. Do you currently own or operate a business, side hustle, not-for-profit, NGO, foundation, charity, real estate investments, or enterprise?
   • ☐ Yes
   • ☐ No, but I’m planning to
   • ☐ No, I work within an organization (intrapreneur)
7. If yes, what’s your enterprise called and what does it do? (Open-ended)

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8. What stage is your enterprise at?
   • ☐ Idea stage
   • ☐ Pre-revenue
   • ☐ Revenue generating but not yet profitable
   • ☐ Profitable and growing
   • ☐ Mature and stable
   • ☐ I’m just exploring entrepreneurship
9. What are your top 3 business, real estate or professional goals right now?

_________________________________________________________________________

_________________________________________________________________________

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10. What’s holding you back from achieving those goals?

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💡 Mindset & Motivation

11. Have you taken the ECQ quiz?

• ☐ Yes
• ☐ No
  (If not, please try the free test: https://brucemfirestone.com/quiz/ecq-quiz/)

12. Why do you want to work with a coach at this time?

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13. What kind of support do you think you need most? (Check all that apply)

• ☐ Strategic direction
• ☐ Business modelling & monetization
• ☐ Marketing and client acquisition
• ☐ Revenue growth
• ☐ Financing
• ☐ Real estate development
• ☐ Mindset and accountability
• ☐ Something else (please specify): ___________________________________________

14. How committed are you to investing time, energy, and resources into your personal and business growth over the next 6–12 months?
    (Scale from 1–10)
15. What do you want most from a coaching relationship?

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📈 Fit & Readiness

16. Have you worked with a coach or mentor before?

• ☐ Yes
• ☐ No

17. If yes, what worked and what didn’t?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

18. Are you looking for:

• ☐ One-on-one coaching
• ☐ Group coaching
• ☐ Occasional advisory calls
• ☐ Not sure yet

19. How do you prefer to work?

• ☐ Structured sessions with action steps
• ☐ More fluid, creative brainstorming
• ☐ A mix of both
• ☐ Online via Zoom
• ☐ In-person
• ☐ A mix of both
• ☐ Other (please describe): ______________________________

20. Are you willing to be challenged and held accountable?

• ☐ Yes
• ☐ No
• ☐ Not sure

🧭 Alignment

21. What is your WHY – your personal and/or professional mission?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

22. What would success look like 12 months from now if we worked together?

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23. Is there anything else you’d like Prof Bruce to know before you connect?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

✅ Final Step

24. How soon are you looking to start coaching?

• ☐ Immediately
• ☐ Within 30 days
• ☐ 1–3 months
• ☐ Just exploring for now

Please return this form to:

Bruce M Firestone, B Eng (civil), M Eng-Sci, PhD
Real Estate Investment and Business Coach
Ottawa Senators Founder
ROYAL LePAGE Performance Realty Broker
📞 613-762-8884
✉️ bruce@brucemfirestone.com
🌐 brucemfirestone.com
🔗 linkedin.com/in/profbruce