New Client Intake Questionnaire

Please take 2 minutes to fill out this quick form before your scheduled maintenance visit so I can prepare your custom home safety file.

1. General Property Information

• Full Name: ___________________________________

• Property Address: ___________________________________

• Best Contact Phone (Cell for Texts): _________________________

• Gate Code / Community Access Info (if applicable): ______________

• Property Type: [ ] Single Family Home [ ] Condo / Townhouse [ ] Manufactured Home

2. Maintenance & Filter Specifications

To ensure I have the right safety data—or if you want me to pick up supplies ahead of time—please provide your system sizes if known:

• AC Filter Size(s): ________________ (Example: 20x20x1)

• Refrigerator Brand / Model (for Water Filter): ________________ (Example: Samsung French Door)

• Smoke Detector Battery Type: [ ] Standard 9-Volt [ ] AA Batteries [ ] Unsure / Built-in 10-Year Lithium

• Water Heater Location: [ ] Garage [ ] Indoor Closet [ ] Exterior Closet

• Dryer Vent Exit Location: [ ] Roof [ ] Side Wall [ ] Lanai / Ground Level

3. Safety & Operational Boundaries Check

• Are any of your burned-out light bulbs or smoke detectors located on ceilings higher than 10 feet?
  [ ] Yes [ ] No
  (Note: For safety and insurance reasons, our tools and ladders are strictly capped at a 10-foot maximum working height).

• Will you be supplying your own filters, batteries, and bulbs for free installation?
  [ ] Yes, I will have them ready on the counter.
  [ ] No, please buy them for me. (I agree to pay the exact retail store receipt cost with zero markup).

• Are there any pets on the property?
  [ ] Yes [ ] No
  (Note: For the safety of your pets and the technician, all animals must be securely locked in a separate room or crate during the 2-hour service window).