Oxford Mermaid Survey Questionnaire
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Contact Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (00000) 000-000.
Email
*
example@example.com
Address
*
First line of address
Street Address Line 2
City
State / Province
Postal Code
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What type of building is needing the bath lift?
*
Detached house
Semi Detached house
Bungalow
Flat
Other
What type of bath?
Standard
Corner
Jacuzzi
Elevated
Island or Peninsula
Other
Are there any technical drawings?
*
Yes
No
Please upload any supporting documents and photo's of bathroom:
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Choose a file
These will be of great help :)
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of
If no drawings, please supply dimensions of the room, to include bath length x width, internal length x width would be helpful :)
We need to know how much space there is for lift to turn with service user
What floor is the hoist on?
*
Ground
First Floor
Other
Is there an adjacent toilet toilet or Sink?
*
Yes
No
What type of floor is the bath sitting on?
*
Wood
Concrete
Don't know
Is there easy access under the floor boards?
*
Yes
No
Unknown
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Is there easy parking near the building for the surveyor?
*
Yes
No
Is there a complete by date?
-
Day
-
Month
Year
Is there a deadline?
How will the project be funded?
*
Private
Charity
Government Grant
Local Loan Store (NHS)
Other
Please verify that you are human
*
Submit
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