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Your full name *
Street Address
City *
State *
Zip *
Your email *
Home Phone
Work Phone
Cell Phone
Type of Consultation *	Suspected Mold Problem  Indoor Air Quality  Water Intrusion
Additional Information	Additional Information - Along with mold, there are many factors that contribute to poor indoor air quality issues. The following information will help us to better diagnose your particular situation, however if you prefer we can collect this information at the time of our initial phone contact.
Commercial or residential property?	Commercial  Residential
Do you own or rent the property?	Own  Rent
Age of structure or year constructed:
Square footage or # of bedrooms:
Attic space?	Yes  No
Crawlspace under structure?	Yes  No
How long have you occupied the property in question?
List past or present water intrusions, including when and where they occurred:
Evident musty odors and/or visible mold or water stains (if none, state "None")
Do any of the occupants have health symptoms and if so what types (e.g. headaches, sinus infections, watery eyes, asthma, skin rashes)?
If there are symptoms, are they more pronounced when in the property?	Yes  No
What type of structural remodeling has the property undergone?
Central HVAC system?	Yes  No
Location of air handler(s) (usually basement or attic):
Is the HVAC fitted with HEPA or some other type filtration?	Yes  No
How often is routine maintenance performed on HVAC system?
Air purifiers / ionizers / ozone generators used?	Yes  No
Age of roof?
Age of windows?
Are the windows single or double pane?
How often is a professional cleaning service used (cleaning services can introduce contaminants from other job sites if they don’t properly maintain their equipment)?
Has carpet ever been steam cleaned and if so, did carpet remain wet for more than 24 hours?
Are there any newly (within 6 mos.) painted rooms?	Yes  No
Central vacuum or personal vacuum (check all that apply)?	Central Vac  Personal Vac
What type of pets (if any) do you have?
Comments or Questions	Use this space to enter any questions or comments
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