Client Intake Form - ScopeX Media

Business Information

Tell us who you are and how to reach you.

What are you trying to achieve and what do you need help with?

Be direct — knowing your real budget means no surprises on either side.

Referral Name (if someone referred you — we want to thank them)

Share what you have — handles, links, or URLs. Leave blank if it doesn’t exist yet.

Don’t share passwords here. Just confirm what exists. ScopeX will arrange secure access during onboarding.

Google Reviews — Current Rating u0026 Number of Reviews

Anything we haven’t covered — vision, concerns, or context for your first call.

What does your business look like in 3 years if everything goes right?

I confirm the information above is accurate and I am authorized to engage ScopeX Media on behalf of this business.

I agree to be contacted by ScopeX Media at the phone number and email provided above.

Gery personally reviews every intake and will reach out within 1 business day to confirm next steps and book your strategy call.