Sales Prospecting intake form

Please fill out the following questionnaire as thoroughly as possible. The more information we have, the higher the prediction capability of finding meaningful contacts for your organization.

If you’d like to send us any supporting files or documents to further optimize the intake process, please send to

For your convenience, the list of questions below can also be downloaded HERE.

Name *
Phone *
Best phone number to call or text you, if needed.
If so, please describe how (e.g. automates manual tasks, CMS penalty avoidances, reduces supplies/material costs...etc.)
If so, please describe how (e.g. captures CPT codes x,y,z or enables more patients to be seen per provider, improves charge capture for reimbursement...etc.)
Please share your full list of current & past customer accounts. 1. List the city and state for each. 2. Indicate if the account is a health system, hospital, provider group, or other type of entity.
For each of the customer accounts, please list the PEOPLE who are making or influencing the buying decisions. 1. Names 2. Titles 3. Describe what drove their buying decision (e.g. building a centralized referral center, need a simplified formulary verification workflow...etc.).
For each customer, tell us about the overall process, such as: 1. Channel or organic sale? 2. What was your initial point of entry? (e.g. an event, a lower level influencer that elevated your pitch...etc.) 3. Which contact, at each customer account, helped move the deal along? 4. Which contact, at each customer account, made the internal sale to colleagues and higher level decision makers? 5. What was the biggest hurdle/challenge you had to navigate in each sales cycle
Which customers were the easiest to close and why? (e.g. channel sale that influenced the buying decision by x,y.z...etc.)
Which customers were the hardest to sell, and why?
Which customers were outliers for things like: 1. Deal size (large or small) 2. Unusual sales cycle length (short or long)? 3. Pilot or nontraditional contract? List other factors, if possible.
ACCOUNTS: Please share your full list of active prospects in your current pipeline. 1. List the city and state 2. Indicate if the prospect is a health system, hospital, provider group, or other type of entity. PERSONAS Please list the people you are engaged with at each prospect account including: 1. Names 2. Titles 3. Their role: Influencer, Maker, Blocker...etc.
Please describe the ideal accounts you'd like to sell to including: 1. Size 2. Location 3. Buying signals (e.g. building or implementing a process or tool that facilitates your product's sales) process) 4. EHR 5. Ownership (e.g. health system owned provider groups versus independent providers...etc.) 6. Any other indicators you can think of.
Describe your ideal decision maker, influencer, and point of entry contact. For each persona, please include: 1. Job titles 2. Topics they care about 3. Pain points they want to solve 4. Budget (e.g. they have one and it's under CMIO's P&L...etc.)
Please describe any criteria that would disqualify a prospective account from being an ideal buyer?
Even if the account type is ideal, describe which types of decision makers do you not want to sell to? 1. Titles 2. Roles 3. Why they are not ideal?
Since our AI tool can cull the internet for contacts 10,000x faster than a human, you can access "lower level" contacts that you would otherwise not have the time or resources to search for. For example, if your product automates physician lab review, rather than targeting the CMIO, CMO, or Medical Directors, you can now target office managers, medical assistants, nurses, and individual physicians. Please list some of these personas/titles.
Please list all the events that your customers and ideal prospects attend.
Please list every possible key term that applies to your product sale. For example, these are terms that: 1. Describe your product 2. Describe the problems you solve 3. Describe the consequences an account faces if they don't solve the problem 4. Initiatives that your product can impact (e.g. patient engagement, provider satisfaction, telehealth) 5. Describe workflows, software, processes your product "touches" 6. Regulatory, FDA, reimbursement topics that involve your value proposition 7. Any other key terms you can list. The more you list, the better the results!
Is there anything else you'd like to share?