CONFIDENTIAL ASSESSMENT · EXECUTIVES ONLY

Agency Fit Questionnaire

Takes about 3 minutes. Your answers help us use our time together well.

CRITERIA & QUALIFICATION NOTICE

This evaluation is reserved exclusively for operating home care agency owners committed to transitioning from day-to-day operations into a scalable enterprise. This questionnaire helps us confirm we're the right fit before we meet. Not every applicant will qualify, and that's by design. It protects your time and ours. Incomplete questionnaires or submissions from non-owners will not be reviewed.

Complete the Assessment

Please provide accurate agency metrics below. Your data is kept strictly confidential and determines if you're a good fit for our Operator to Owner Accelerator.

Step 1 of 6 Strictly Confidential

1) Contact details

Please enter your details so we can review your responses and follow up appropriately.

Full name

Phone

Agency name

2) How did you hear about us?

Select one.

Referred by someone Webinar Instagram Facebook Conference or speaking event Google search Other

4) What state is your agency licensed in?

Select one.

State

5) What type of care do you provide?

Select all that apply.

Non-medical / companion care Medicaid waiver Private pay VA Medicare / skilled home health Not yet providing care

6) How long have you been in business?

Select one.

Not licensed yet Licensed, not yet serving clients Less than 1 year 1–2 years 3–5 years 5+ years

7) What is your agency's current annual revenue?

Select one.

Under $100K $100K–$299K $300K–$599K $600K–$999K $1M–$1.5M Over $1.5M

8) How many active clients do you currently serve?

Select one.

0 1–10 11–25 26–50 51–100 100+

9) How many caregivers are on your team?

Select one.

0 1–10 11–25 26–50 51+

10) Who handles the office side of the business besides you?

Select one.

Just me 1 person 2–3 people 4 or more I have a VA

11) What are you struggling with most right now?

Select up to 3.

0 of 3 selected

Operations and scheduling HR: hiring, onboarding, keeping caregivers Revenue and getting new clients Billing, payroll, or cash flow No documented systems or SOPs No CRM or way to track leads and clients Holding my team accountable Compliance and audit readiness Doing everything on my own Honestly, all of it

12) How many hours a week are you working in the business?

Select one.

Under 30 30–45 46–60 60+

13) If nothing changes in the next 12 months, what does that cost you?

Short answer.

Your answer

14) How do you prefer to fix what's not working?

Select one.

Hands-on with a coach and team who build it with me Guidance from a coach, I'll execute myself I prefer a course and figure it out on my own

15) How serious are you about implementing in the next 90 days?

Select one.

Ready now, I'm making room for this Serious, but timing is 1–3 months out Just exploring for now

16) If we're a fit, are you in a position to invest in your agency's infrastructure within the next 30 days?

Select one.

Yes I'd need to plan for it Not right now

17) Who makes the final decision on investments in your business?

Select one.

Just me Me and a business partner (they'll attend the call) Someone else

18) Strategy calls are diagnostic and require your full attention.

Do you commit to showing up on time, on camera, with any decision-makers present?

Yes, I commit No

MASTHERMIND CO.

Agency Fit Questionnaire

CRITERIA & QUALIFICATION NOTICE

Complete the Assessment