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Free assessment request

Collects business type, current challenges, volume and goals to qualify and book a free assessment call.

Use this template

Free to use. Start with your Google account and the form opens in the editor.

Who it is for

For agencies, consultants and software vendors who use a free assessment to capture leads and track them to conversion.

What you get

  • 12 questions on 2 pages
  • 3 logic rules that show follow-up questions or update calculations
  • Inbox statuses: New, Contacted, Diagnosed, Converted, Not a fit, Spam
  • An email alert for every new response
  • Everything stays editable: questions, options, logic and statuses

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Template preview

Free assessment request

Tell us where you are today and a specialist will review it for free. We get in touch within two business days.

Your business

Business type
Required
  • 1.Online store / retail
  • 2.Restaurant / café
  • 3.Local services
  • 4.Education / academy
  • 5.Software / IT
  • 6.Manufacturing / distribution
  • 7.Freelancer / solo business
  • 8.Other
What are your main challenges? (select all that apply)
Required
  • Not enough new customers
  • Low conversion
  • Weak repeat business
  • High acquisition or operating cost
  • Manual, inefficient operations
  • Low brand awareness
  • Other
Tell us about the other challenge
Short text
Logic
WhenWhat are your main challenges? (select all that apply)isOther
ThenshowTell us about the other challenge
andrequire an answer toTell us about the other challenge
Monthly volume (orders, leads or revenue)
  • Not started yet
  • Under 100 per month (or under 10M KRW)
  • 100-500 per month (or 10M-50M KRW)
  • 500-2,000 per month (or 50M-200M KRW)
  • Over 2,000 per month (or over 200M KRW)
What is your goal?
Required
e.g. double monthly leads in six monthsLong text

How to reach you

Preferred contact method
Required
  • Phone call
  • Email
  • Text message
Name
Required
Short text
Business name (optional)
Short text
Phone number
+1 555 000 0000Phone
Logic
WhenPreferred contact methodis one ofPhone call, Text message
Thenrequire an answer toPhone number
Email
Email
Logic
WhenPreferred contact methodisEmail
Thenrequire an answer toEmail
Privacy consent
Required
  • I agree that my name, contact details and answers are used to provide this free assessment (kept for one year).
Marketing updates (optional)
  • Send me tips, news and offers. You can still get your free assessment without ticking this.
Ending page

Thank you! We have your request and will reach out by your preferred method soon.

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