Name
*
First Name
Last Name
Email
*
Address
*
Address where you wish for home consultations to occur.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number
*
Which of the following days / times may suit for your home consultation/s?
*
Please select all that apply.
Which of those days / times are your most preferred?
*
Are there any entry or exit points of your home that cannot be accessed or used safely (without tripping over or moving clutter out of the way)?
*
Please tick one.
Are your smoke alarms currently working with batteries changed regularly?
*
Please tick one.
What would you like to accomplish by working with me in your home?
*
When thinking about the spaces in my home, my priorities are:
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Please tick all that apply.
I would like assistance with these areas of my home:
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Please tick all that apply.
The area I wish to start with is:
Which of these do you feel most contributes to clutter in your home?
*
Please tick one.
When items enter your home they are:
*
Please tick all that apply.
How often do you remove items from the home via selling, donations, giving away to someone you know or on "freebie" type groups, or throwing out damaged items?
*
Please tick one.
Which of the following factors have contributed to the current state of your home?
*
Please tick all that apply.
Please select the statements below that apply to you. "I keep or collect items because..."
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When products are required to complete a space (e.g. shelving, containers or dividers), I prefer to:
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Please use this area to share anything else you'd like me to know about yourself, your family or your home...
