Climote Virtual Home Energy Assessment
Name
*
First Name
Last Name
Email
*
johnsmith@example.com
Mobile Phone Number
*
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Do you own or rent your home?
Own
Rent
Is it a House or Apartment?
House
Apartment
How Many Bedrooms are there
1-2
3-4
5+
How old is your House? (Years)
0-10
10-20
20-30
30-40
40+
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What prompted you to ask for the VHEA?
Energy Efficiency concerns
Reducing your Bills
Improve comfort of your home
All of the above
Do you know your House BER certificate? (Building energy rating)
A-B
C-D
E-F
G
Don't Know
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Do you have Oil or Gas?
Oil
Gas
Other
If Other Please Specify
How old is your Boiler? (years)
0-5
5-10
10-15
15+
When did you last have your Boiler serviced? (Years)
Less than a year ago
1-2
3-5
5+
Is your Boiler serviced routinely?
Yes, Every Year
No
If yes, who services Your Boiler?
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When you switch on your heating can you control your heating by individual zones in the home?
No, House is not Zoned
Yes, House is zoned, 1 Zone
Yes House is Zoned, 2 Zones
Yes House is Zoned, 3+ Zones
How do you control your heating?
Old Time Clock - Manually Set
Smart Heating control (controlled by App)
Name of Smart Heating Control?
If you have a Smart heating control how did you get it?
From an Energy Company
I Bought It Myself
I don't have a Smart Heating Control
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How do you control your hot water?
Immersion Heater
Heat water directly from the Gas Boiler
Heat water using an Oil Boiler
Both - Heat using Immersion and Boiler
Can you control your Hot water using an app?
Yes
No
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Do you feel like your Energy Bills are High?
Yes
No
Average
Type option 4
On a scale of 1-5 how high are they?
1
2
3
4
5
Low
High
1 is Low, 5 is High
When you switch your heating off, does your house cool down quickly?
Yes, in less than One Hour
Yes, 1-2 Hours
No, House Retains Heat well
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Have you considered making any of the following changes to improve the efficiency and comfort of your home?
Smart heating and Smart Hot water Controls
Insulation
Solar Panels
Boiler replacement
Purchasing an Electric vehicle
New Windows or Doors
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How long do you plan to stay in your Current Home?
1- 2 Years
2-5 Years
5-10 Years
10+ Years
Who is Your current Energy Supplier
Are you in a contract with them?
Yes
No
Not sure
Are you happy to receive communication from us regarding a Virtual Home Energy assessment?
Yes - I'm happy to receive communications
No - i would prefer not too
The Next Steps are to arrange your Virtual home Energy Assessment. Please select a time for our Virtual Home Energy assessor to survey your property (This takes 10 - 15 Minutes)
Appointment
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