Client Onboarding Form

📋 Section 1: Basic Information & Company Profile

Contact Information

Agency Legal Name *

Doing Business As (DBA) - if different

Primary Contact Name *

Title/Role *

Your Email Address *

Phone Number *

Agency Website

Physical Address (City, State, ZIP)

Company History & Structure

Year Founded *

Years in Operation *

Business Structure

Sole Proprietorship Partnership LLC (Limited Liability Company) S-Corporation C-Corporation

Ownership Structure

Single Owner Multiple Partners/Owners Family-Owned Business Investor-Backed

Number of Locations/Branches

Service Area Coverage

Estimated population in service area

Current Scale & Operations

Current Active Clients *

Current Active Caregivers *

Total Full-Time Administrative Staff

Total Part-Time Administrative Staff

Total Weekly Client Service Hours

Average hours per client per week

What percentage of clients are in each care level?

Light care (1-20 hrs/week)

Medium care (21-40 hrs/week)

Heavy care (40+ hrs/week)

💵 Section 2: Financial Performance & Analysis

Revenue & Growth

Approximate Annual Revenue (Last 12 months) *

Approximate Monthly Revenue (Current)

Year-over-year revenue growth rate

Declining Flat (0-5%) Moderate growth (5-15%) Strong growth (15-30%) Rapid growth (30%+)

Revenue by Payer Source (estimate % of total revenue)

Payer Source	% of Revenue	Avg Reimbursement Rate/Hour
Private Pay
Medicaid
VA Benefits
Insurance/Other

👥 Section 3: Recruitment & Caregiver Management

Caregiver Compensation & Benefits

Caregiver Pay Structure

Position Type	Hourly Rate Range	# of Caregivers
Entry Level Caregiver	$ - $
Experienced Caregiver (1-3 years)	$ - $
Senior Caregiver (3+ years)	$ - $
Certified/Specialized (CNA, HHA, etc.)	$ - $

How does your pay compare to local competitors?

Below market rate At market rate Above market rate Not sure/Haven't researched

Do you offer pay increases or raises?

Yes - On a regular schedule (annual, etc.) Yes - Performance-based Occasionally/Case by case No formal raise structure

📈 Section 4: Business Development & Client Acquisition

Client Acquisition Metrics

How many new inquiries do you receive per month?

How many new clients do you start per month?

What is your inquiry-to-client conversion rate?

New clients ÷ Inquiries × 100. Industry average is 20-40%

What is your average client acquisition cost?

Total sales & marketing costs ÷ Number of new clients

What is your average client lifetime value?

Average revenue per client × Average length of service

What is your average client retention period (months)?

What is your client attrition/churn rate (annual)?

📢 Section 5: Marketing & Brand Positioning

Brand & Reputation

Online review presence:

Platform	# of Reviews	Average Rating
Google
Facebook
Caring.com

Do you actively request reviews from satisfied clients?

Yes - Systematic process in place Yes - Occasionally ask No - Rely on organic reviews

Do you have brand guidelines (logo usage, colors, messaging)?

Yes - Comprehensive and documented Yes - Basic guidelines No formal guidelines

What makes your agency different from competitors?

What are your biggest marketing challenges?

📅 Section 6: Scheduling & Care Coordination

Time Tracking & EVV Compliance

How do caregivers clock in/out?

EVV Mobile App Telephony (IVR) System Fixed device at client location Paper timesheets

Is your EVV system compliant with state/federal requirements?

Yes - Fully compliant and verified Yes - Working toward full compliance Uncertain/Need to verify No - Not yet compliant EVV not required for our payer mix

What percentage of timesheets require manual adjustments?

What are your biggest scheduling challenges?

⚙️ Section 7: Operations & Infrastructure

✓ Section 8: Quality Assurance & Client Satisfaction

💰 Section 9: Accounts Receivable & Payment Management

AR Performance & Collections

What is your average AR aging? *

0-30 days (Excellent) 31-45 days (Good) 46-60 days (Needs attention) 61-90 days (Problematic) Over 90 days (Critical)

Total accounts receivable outstanding (approximate):

What percentage of your revenue is currently outstanding?

AR aging breakdown (if known):

0-30 days

31-60 days

61-90 days

90+ days

What is your bad debt write-off rate annually?

Payment Reconciliation

How often do you reconcile payments received?

Daily Weekly Monthly Quarterly Rarely/Irregularly

Do you have a collections process for overdue accounts?

Yes - Systematic with documented steps Yes - Informal approach No formal process

What are your biggest billing and AR challenges?

💻 Section 10: Technology & Systems

📋 Section 11: Compliance & Regulatory

🎯 Section 12: Strategic Goals & Future Vision

Consulting Support Needs

Which areas would you most like consulting support with? (Rank top 3)

Financial Management & Profitability Recruitment & Retention Strategy Business Development & Sales Marketing & Brand Development Operations & Process Improvement Technology & Systems Quality Assurance & Compliance Leadership Development & Team Building Strategic Planning & Growth Strategy

What does success look like for your agency in 3 years?

Additional comments, specific concerns, or anything else you'd like us to know:

How did you hear about Briones Consulting Group?

🏥 Comprehensive Homecare Agency Assessment

📋 Section 1: Basic Information & Company Profile

Contact Information

Company History & Structure

Services & Operations

Current Scale & Operations

💵 Section 2: Financial Performance & Analysis

Revenue & Growth

Profitability & Margins

Cash Flow & Financial Health

👥 Section 3: Recruitment & Caregiver Management

Recruitment Pipeline & Metrics

Caregiver Compensation & Benefits

Retention & Turnover

Onboarding & Training

📈 Section 4: Business Development & Client Acquisition

Client Acquisition Metrics

Referral Sources & Partnerships

Sales Process & Conversion

📢 Section 5: Marketing & Brand Positioning

Digital Presence & Marketing Channels

Brand & Reputation

📅 Section 6: Scheduling & Care Coordination

Scheduling Systems & Processes

Time Tracking & EVV Compliance

⚙️ Section 7: Operations & Infrastructure

Organizational Structure & Roles

Communication & Meetings

Performance Tracking & KPIs

✓ Section 8: Quality Assurance & Client Satisfaction

Client Satisfaction & Feedback

Supervisory Oversight

💰 Section 9: Accounts Receivable & Payment Management

AR Performance & Collections

Billing Operations

Payment Reconciliation

💻 Section 10: Technology & Systems

Software & Systems Inventory

Data & Reporting

📋 Section 11: Compliance & Regulatory

Licensing & Regulatory Status

Personnel Compliance

🎯 Section 12: Strategic Goals & Future Vision

Business Goals & Growth Plans

Consulting Support Needs

Contact us now

317-406-6814

The Briones Group

info@thebrionesgroup.com

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Briones Consulting Group