MMIC Image Worksheet

If you are contemplating taking the next step or just have a few questions you would like to ask, MMIC wants to talk to you! Please complete the image worksheet and send it to us. Once the sheet is submitted, we will review it and set a time for Christine to call you to discuss your goals and any questions you may have.

As you complete your answers, be sure to take your time as this is your opportunity to take inventory of your current image and where you would like to be. Answer as honestly as possible, and add any additional information you would like to provide in the "Notes" section at the end of the worksheet. All information is kept confidential.

You can fill out the form below or download a PDF or Word Document.

Download PDF, Click Here.

Download Word Document, Click Here.

Image Worksheet

Date:

Name:

Address:

Primary Phone:

Secondary Phone:

E-mail Address:

Birth Date:

In three sentences tell me about yourself:

What prompted you seek out an image consultant?

What do you do for a living?

Are you married/ partnered/ divorced/ single? If in a relationship, how long have you been together?

What is your favorite color?

What do you do for fun?

How would you say others view you?

How do you want others to view you?

If you could change two (2) things about your appearance, what would they be and why?

Do you exercise? How often?

Do you have a favorite outfit? Describe it:

Where do you typically shop for clothes? How often do you shop?

How many pairs of jeans do you own? What size?

How many pairs of shoes do you own?

What jewelry or accessories typically wear?

What fragrance(s) do you wear?

How often do you get your hair cut?

Are you balding or wear a hair piece?

Do you have facial hair? If yes, please describe:

Do you currently use skin care products? If so what type and brand?

NOTES:

Modern Male Image Consulting is based in Austin Texas and provides male makeovers throughout Texas and Nationwide!

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MMIC Image Worksheet

888-208-3091