Pick My Brain Session Questionnaire

Thank you for scheduling a Pick My Brain session! I am looking forward to learning more about your online course and/or training needs.

You will receive:

One 60-minute meeting (conducted via phone or Zoom)
A detailed post-meeting document that summarizes key discussion points, relevant topic resources and 2+ action steps that align with your goals

Single Session= $200 USD.

Four-Pack of Sessions= $700 USD.

This session will offer tailored support on topics of interest. For this reason, I need to get to know you and your goals a little better in order to lead the most effective session possible.

*All information shared here and during sessions is kept private within Roman Public Health Consulting LLC. It is only used to confirm that a Pick My Brain session is a good match for your needs and to provide tailored advice and resources.

Name

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

I can be BEST described as a:

Public Health Consultant/Entrepreneur

Public Health Organization Staff

School of Public Health Faculty/Staff

Public Health Training Center Faculty/Staff

Other (Please describe below)

If other, please describe:

What is your business or organization name?

Write N/A if not applicable

Please write a short description of your business or organization.

E.g., Mission, ideal client, services provided, etc. Write N/A if not applicable

Business or Personal Website

Write N/A if not applicable

http://

What are your top 1-3 questions you want to make sure we discuss during our session?

What is currently your biggest challenge in designing or developing this course or training?

Do you have any questions about the session that I can answer?