It's officially called the "Scope Analysis Worksheet" from Level 3 of The Level 5 Advisory Training Program.

I want you to use this tool as a guide for interviewing current or prospective clients. Walk them through the areas of their business, filling out the form as you go.  I generally start with the bottom right corner.  Ask them "Why are you in this business?"  Then send them the completed form as a meeting follow-up.  Be prepared to make an impact.