CLIENT INTAKE FORM

CLIENT INTAKE FORM
Name*

First NameLast Name
Mobile Number
Format: (000) 000-0000.
Email*
example@example.com
Alternate Phone Number (work number)
Format: (000) 000-0000.
Service Address*

Street Address

Unit Number

CityProvince

Postal / Zip Code
Gated Community / Apartment Complex / Townhouse Name
Spouse's Name (if applicable)

First NameLast Name
Spouse's Contact Number (if applicable)
Format: (000) 000-0000.
Preferred contact method for appointment updates:

TextPhoneCallEmail
Do you have a separate billing address?

Yes
Billing Address (if different from above)

Street Address

Unit Number

CityProvince

Postal / Zip Code
PAYMENT
If you are booking a one time service such as a move-in, move-out or one time deep clean, we require a 50% deposit. If you are booking an ongoing maintenance cleaning service, you do not need to leave a deposit.*

I agree
Preferred Payment Method*
SCHEDULING / TYPE OF SERVICE
Preferred Service Date*

MonthDayYear
Date
Alternate Service Date*

MonthDayYear
Date
Type of Service Required*
Frequency Required*
SAFETY FOR OUR EMPLOYEES

Is there any potential safety risks that our team should be aware of?
Driveway / sidewalk / entry: any safety concerns or tripping hazards?*
Is there any renovations or construction in or around your home?*
Any seasonal safety concerns?*

IceFloodingUneven groundNot applicable
YOUR HEALTH
Do you or anyone in your home have any health conditions we should be aware of? (leave it blank if your answer is "no")

Yes
Health Information

Are you mobility compromised?Do you have any major health concerns we should be aware of?Do you have any allergies we should be aware of?Do you have any scent sensitivities?
PARKING / SECURITY / MEANS OF ENTRY
Parking Available? Special Instructions (if any)*
Security / Alarm Code (if applicable)
Primary entry method:*
Primary entry method:*

Door codeLockboxClient homeKey under mat or specify belowConciergeOther
Specify "Other" entry method
Lockbox location / code (if applicable)
Key location (if applicable)
Gate or building access code if applicable:
Backup entry method if primary fails, call this number:*
Please enter a valid phone number.Format: (000) 000-0000.
PEOPLE / PETS IN HOME
Please note: if you have pets please secure your pets it is not the responsibility of LHS to manage your furry friends.
How many people live in your home?
What type of pets do you have? (if applicable)
How many pets in your home?
Pet Name(s)
Where will your pets be during cleaning?

Contained in a roomOutsideCratedFree roaming - please note we require pets to be secured
HOME DETAILS
What is the approximate size of your house?
How many levels of home do you have?
How many bedrooms do you have?
How many bathrooms do you have?
HOME / HISTORY / CONDITION
On a scale of 1 - 10, how cluttered is the place you need cleaned? (1 being not cluttered at all and 10 being very cluttered)
Home age*

< 5 years6 - 10 years11 - 20 yearsOlder home
Have you had professional cleaning in your house before?*

YesNo
If yes, when was the last time you had the professional house cleaning?
MAINTENANCE CLEANING WORK ORDER

Please select your priorities below and feel free to check all that apply. Unless otherwise noted, our team will follow our standard workflow in your home. **SPECIAL REQUESTS: are located at the bottom of the form.
ON A BUDGET? PREPARING FOR YOUR CLEANING SERVICE WILL HELP YOU SAVE MONEY

(optional) Pick up any clothing, toys or whatever else has found it’s way to your floors or countertops, clear away dirty dishes and food messes. The less clutter you have the easier it will be for your house cleaner to focus on the more important tasks!
MAID SERVICES ARE AVAILABLE

LHS provides regularly scheduled MAID SERVICES to help make out client's lives easier! Some examples are washing and folding laundry, making beds, dishes etc. Please contact the office or leave a note in the special requests section at the end of this form.
Are there any areas or items you specifically do not want cleaned?
Special Requests
Primary countertop material in your home:

GraniteQuartzLaminateMarbleTileOther
KITCHEN
Kitchen Maintenance Service

DustingSpot clean cupboardsStovetopMicrowaveCounters/appliancesSinkFloors
What type of flooring do you have in the kitchen?
KITCHEN #2

If applicable
If you have a second kitchen in your home you would like cleaned, please select "yes", if you do not, please leave the selection blank.

Yes
Kitchen Maintenance Service

DustingSpot clean cupboardsStovetopMicrowaveCounters/appliancesSinkFloors
MAIN BATHROOM
Bathroom Maintenance Service

DustLight fixturesShowerTubCountersSinkToiletFloors
What type of flooring do you have in the bathroom?
BATHROOM #2

If any (not the ensuite bathroom)
Bathroom Maintenance Service

DustLight fixturesShowerTubCountersSinkToiletFloors
What type of flooring do you have in the bathroom?
MASTER BEDROOM
Master Bedroom Maintenance Service

Dusting furnitureDusting baseboardsDusting blindsStraighteningVacuuming
What type of flooring do you have in the master bedroom?
ENSUITE BATHROOM

If applicable
Bathroom Maintenance Service

DustLight fixturesShowerTubCountersSinkToiletFloors
What type of flooring do you have in the ensuite?
BEDROOM #2
Bedroom #2 Maintenance Service

Dusting furnitureDusting blindsStraighteningVacuuming
What type of flooring do you have in the bedroom?
BEDROOM #3
Bedroom #3 Maintenance Service

Dusting furnitureDusting blindsStraighteningVacuuming
What type of flooring do you have in the bedroom?
BEDROOM #4
Bedroom #4 Maintenance Service

Dusting furnitureDusting blindsStraighteningVacuuming
What type of flooring do you have in the bedroom?
BEDROOM #5
Childs / Spare Room #4 Maintenance Service

Dusting furnitureDusting blindsStraighteningVacuuming
What type of flooring do you have in bedroom?
LIVING / FAMILY / REC ROOM
Living / Family / Rec Room Maintenance Service

Dusting furnitureDusting blindsStraighteningVacuumingWash floors
What type of flooring do you have in this room?
MEDIA / THEATER ROOM
Living / Family / Rec Room Maintenance Service

Dusting furnitureDusting blindsStraighteningVacuumingWash floors
HOME OFFICE
Home Office Maintenance Service

Dusting furnitureDusting blindsStraighteningVacuumingWash floors
LAUNDRY / UTILITY ROOM
Laundry/ Utility Maintenance Service

DustWipe washer/ dryerVacuum floor
ENTRY
Entry Maintenance Service

StraightenDust/ vacuum/ wash floors
Do You Have a Basement?
Basement Service

Yes - finished and included in the cleanNo - not included
Basement cleaning details
OTHERS
How did you hear about us?*
Additional Comments/Notes
Kindly attach photos of the areas you wish to be cleaned

Cancelof
I consent to receive automated text messages (SMS) from Lifestyle Home Service at the mobile number provided above. Messages may include appointment confirmations, scheduling updates, arrival notifications, invoice notifications and service reminders. You may opt out at any time by replying STOP.*

I consent
Should be Empty:

CLIENT INTAKE FORM

PAYMENT

SCHEDULING / TYPE OF SERVICE

SAFETY FOR OUR EMPLOYEES

YOUR HEALTH

PARKING / SECURITY / MEANS OF ENTRY

PEOPLE / PETS IN HOME

Please note: if you have pets please secure your pets it is not the responsibility of LHS to manage your furry friends.

HOME DETAILS

HOME / HISTORY / CONDITION

MAINTENANCE CLEANING WORK ORDER

ON A BUDGET? PREPARING FOR YOUR CLEANING SERVICE WILL HELP YOU SAVE MONEY

MAID SERVICES ARE AVAILABLE

KITCHEN

KITCHEN #2

MAIN BATHROOM

BATHROOM #2

MASTER BEDROOM

ENSUITE BATHROOM

BEDROOM #2

BEDROOM #3

BEDROOM #4

BEDROOM #5

LIVING / FAMILY / REC ROOM

MEDIA / THEATER ROOM

HOME OFFICE

LAUNDRY / UTILITY ROOM

ENTRY

Do You Have a Basement?

OTHERS