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New Client Survey - Social Services
Hello and Thank you for choosing Coach Candice.

C.A. Ellis & Associates, LLC. is a conglomerate of services delegated to aid individuals and small businesses to be the best version of themselves by “piecing together the pinnacle of success.” C.A. Ellis & Associates, LLC. is a sole proprietorship limited liability corporation owned and operated by Candice Ellis located in Eagan, Minnesota. C.A. Ellis & Associates, LLC. is a CERT certified small women minority owned business.

The mission of C.A. Ellis & Associates, LLC. dba as Coach Candice Is to provide fast and reliable services in auditing, consulting, coaching and staff development to comprehensive home care & housing with services, and community residential service providers.

I ask that you send me the following information, as it pertains to your business and the services you desire, once we have decided that you would like to move forward:
• Copy of licenses
• Copy of Contractual Services
• House Schedule/Staffing Pattern per residence
• List of residential site (name, address, primary contact for each site)
• Company on board paperwork for:
o Staff including however not limited to federal documents, policies & procedures, job description; employee
handbook including mission and vision statement
o Client including however not limited to policies & procedures, lease, if applicable
• Any advertisement material you are currently using in to market your business
• Written notice of dementia care training, if applicable (HWS)
• Source of training – i.e. name of online platform, agency, individual
• Site Program Abuse Prevention Plan (PAPP) for each site
• Latest Correction/Survey/Licensing/Internal Review paperwork
What is the name of the organization/company? *
Your answer
What is your business website?
Your answer
What is the best telephone number to reach you on? *
Your answer
What is the business mailing address? *
Your answer
What is your email address? *
Your answer
How long have you been in business? *
Your answer
What is the name of the individual completing this survey? *
Your answer
What is your role within the organization? *
Your answer
Are you the decision-maker for the organization? *
If no, who is the decision-maker of the organization? *
Your answer
What brings you to Coach Candice? *
Required
What type of business do you have and/or aspire to have? *
Required
What was your last year estimated revenue for your business? *
Your answer
What is your current projected revenue for your business? *
Your answer
Is there anything pertaining to your general business, which I have not mentioned that you feel is pertinent for me to know to aid in providing you the best service(s)? *
Your answer
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