PERSONAL INFORMATION
Tell me about you..
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
PROJECT INFORMATION
Tell us about the project.
Is this a whole home project or specific room/s?
*
Project Brief
*
What problems can I help you to solve?
*
Areas in the home that don't work effectively for you and your family?
Project Type
*
Please Select
Structural
Cosmetic
Both
Investment bracket for project
*
Please Select
$0 - $10,000
$10,000 - $25,000
$25,000 - $40,000
$40,000 - $70,000
$7o,000 - $100,000
$100,000+
I need your help to understand
Earliest start date
*
/
Month
/
Day
Year
Date
Target end date
*
/
Month
/
Day
Year
Date
Is use of a camera authorised?
*
Yes
No
Are you able to provide relevant documentation i.e. blueprints/ floorplans?
*
Yes
No
LIFESTYLE
Tell us more about you and your family.
Occupation
*
Self Employed
Employed
Student
Retired
Other
Who lives at home?
*
Adults
Children
Adults (over 60)
Pets
Other (non-family member)
If children, please provide age/s & gender/s of children - if pertinent to design?
This helps us to know who to cater for in the design/s
If pets, please what type and how many - if pertinent to design needs?
This helps us to know what needs you may have in the design/s
How does your home/ space currently make you feel?
*
Happy/ Positive
Relaxed/ Calm
Energised / Inspired
Stressed/ Negative
Rushed/ Tired
Cluttered/ Claustrophic
Other
Are there any special requirements to consider e.g. allergies, disabilities, multi-generational living, etc?
What do you do like to do?
*
Working
Travelling
Hobbies
Cooking
Nights In
Nights Out
Reading
Sports
Family Time
Exercising
Entertaining
Hosting Holidays
What is the room most used in the house?
*
DESIGN STYLE
Tell us more about your style and what you like
Which Design Styles do you like?
*
Modern
Traditional
Contemporary
Transitional
Mid-century Modern
Modern Cottage
Minimalist
French Country
Modern Farmhouse
Hollywood Regency
Farmhouse
Coastal Farmhouse
Electic
Modern Organic
Japandi
Scandinavian
Industrial
Maximalist
Industrial Farmhouse
Bohemian
Coastal
Mediterranean
Rustic
Moroccan
Art Deco
Shabby Chic
Retro
Other
What Design Concepts do you like?
*
Cosy
Dramatic
Airy
Cheerful
Functional
Luxurious/ Opulent
Formal
Glamorous
Chic
Feminine
Masculine
Pet friendly
Relaxing/ Laidback
Social
Child Friendly
Order/ Structured
Uncluttered/ Clean Lines
Sophisticated
Elegant
Understated
Other
Which Color schemes do you like?
*
Black
White
Neutral Tones
Warm/ Earthy Tones
Cool Colors
Pastels
Mutes/ Soft
Bold/ Primary
Gem/ Jewel Tones
Monochromatic
Blues
Other
Which metals/ finishes do you like?
*
Black
Chrome
Brushed Nickel
Gold
Copper
Brass
Other
Which surfaces materials do you like?
*
Brick/ Pebble
Textured
Natural Stone
Matte
Man made Stone
Natural Woods
Polished
Man made Woods
Other
NOTES
What else do you want BC Interiors to know?
What are your needs whilst work is being carried out in your home?
Have you ever used an Interior Designer?
*
How did you find the experience?
*
How did you hear of Balisier Concepts Interiors?
*
What made you decide to choose Balisier Concepts Interiors?
*
Thank you!
This information is valuable to us and we appreciate you taking the time to complete!
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