CLIENT INTAKE FORM
Name
*
First Name
Last Name
Mobile Number
Email
*
example@example.com
Alternate Phone Number (work number)
Service Address
*
Street Address
Unit Number
City
Province
Postal / Zip Code
Gated Community / Apartment Complex / Townhouse Name
Spouse's Name (if applicable)
First Name
Last Name
Spouse's Contact Number (if applicable)
Do you have a separate billing address?
Yes
Billing Address (if different from above)
Street Address
Unit Number
City
Province
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
*
Please Select
Electronic Funds Transfer
Credit Card
SCHEDULING / TYPE OF SERVICE
Preferred Service Date
*
 -
Month
 -
Day
Year
Date
Alternate Service Date
*
 -
Month
 -
Day
Year
Date
Type of Service Required
*
Please Select
Move In
Move Out
Regular Clean
Deep Clean
Frequency Required
*
Please Select
One-Time (Move In/ Move Out)
First/ Deep Clean
Weekly
Bi-weekly
Monthly
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?
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)
Means of Entry (key location, will someone be there upon entry)
*
Lockbox location / code (if applicable)
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)
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)
Have you had professional cleaning in your house before?
*
Yes
No
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.
KITCHEN
Kitchen Maintenance Service
Dusting
Spot clean cupboards
Stovetop
Microwave
Counters/appliances
Sink
Floors
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
Dusting
Spot clean cupboards
Stovetop
Microwave
Counters/appliances
Sink
Floors
MAIN BATHROOM
Bathroom Maintenance Service
Dust
Light fixtures
Shower
Tub
Counters
Sink
Toilet
Floors
What type of flooring do you have in the bathroom?
BATHROOM #2
If any (not the ensuite bathroom)
Bathroom Maintenance Service
Dust
Light fixtures
Shower
Tub
Counters
Sink
Toilet
Floors
What type of flooring do you have in the bathroom?
MASTER BEDROOM
Master Bedroom Maintenance Service
Dusting furniture
Dusting baseboards
Dusting blinds
Straightening
Vacuuming
What type of flooring do you have in the master bedroom?
ENSUITE BATHROOM
If applicable
Bathroom Maintenance Service
Dust
Light fixtures
Shower
Tub
Counters
Sink
Toilet
Floors
What type of flooring do you have in the ensuite?
BEDROOM #2
Bedroom #2 Maintenance Service
Dusting furniture
Dusting blinds
Straightening
Vacuuming
What type of flooring do you have in the bedroom?
BEDROOM #3
Bedroom #3 Maintenance Service
Dusting furniture
Dusting blinds
Straightening
Vacuuming
What type of flooring do you have in the bedroom?
BEDROOM #4
Bedroom #4 Maintenance Service
Dusting furniture
Dusting blinds
Straightening
Vacuuming
What type of flooring do you have in the bedroom?
BEDROOM #5
Childs / Spare Room #4 Maintenance Service
Dusting furniture
Dusting blinds
Straightening
Vacuuming
What type of flooring do you have in bedroom?
LIVING / FAMILY / REC ROOM
Living / Family / Rec Room Maintenance Service
Dusting furniture
Dusting blinds
Straightening
Vacuuming
Wash floors
What type of flooring do you have in this room?
MEDIA / THEATER ROOM
Living / Family / Rec Room Maintenance Service
Dusting furniture
Dusting blinds
Straightening
Vacuuming
Wash floors
HOME OFFICE
Home Office Maintenance Service
Dusting furniture
Dusting blinds
Straightening
Vacuuming
Wash floors
LAUNDRY / UTILITY ROOM
Laundry/ Utility Maintenance Service
Dust
Wipe washer/ dryer
Vacuum floor
ENTRY
Entry Maintenance Service
Straighten
Dust/ vacuum/ wash floors
OTHERS
How did you hear about us?
*
Please Select
Google search
Facebook
From a friend
Realtor
Special Requests
Additional Comments/Notes
Kindly attach photos of the areas you wish to be cleaned
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