Conscious Healthy Home Client Application Form

Conscious Healthy Home™ Client Application
Just have a specific question or decision you're stuck on? Book a One-Time Client Call instead of completing this application: HERE
Name

First NameLast Name
E-mail
example@example.com
Phone Number (please use the number you would like me to reach you at for the consultation call)
Format: (000) 000-0000.
Time Zone (note Conscious Healthy Home is on Central Time)
Current Address

Street Address

Street Address Line 2

CityState

Zip Code
Project Scope
Learn more about Conscious Healthy Home's services here.
What services are you interested in exploring?
Are you currently working with a builder or architect, planning to manage the project yourself, or still deciding?
Budget
Outside of consulting costs, what is your estimated project budget?

Other
Property Details (if building, renovating, or remediating)
Property Address
Year Built
Approximate Square Footage
Type of Property (Single-family, Townhome, Apartment)
Current Concerns
What are your primary concerns regarding the health of your living environment? (Check all that apply)

Other
Are you currently working with, or seeking, a medical or health practitioner regarding a mold or biotoxin-related illness?
Practitioner or clinic name (optional)
Are there any specific health conditions or sensitivities in your household that we should be aware of?
Have you been (or are you currently) involved in any litigation regarding this or any prior home purchase/design/build/renovation project(s)?
Project Goals
List your top three (3) goals for this project
When would you like to begin this project, and is there a specific completion date in mind?
Have you worked with healthy home consultants or similar professionals before? If yes, please briefly describe your experience.
Investment
Our services often require a significant time commitment from clients to achieve success. Are you prepared to invest the necessary time in this process, which may include multiple meetings and ongoing communication?
Our services are best suited for individuals committed to making informed, empowered decisions about their project. Does this describe you?
If we determine your goals and our services are a good fit, are you prepared to move forward with the financial investment in our services.
What else do you think we should know?
Is there anything else you'd like to share about your needs or expectations for this project?
How did you hear about Conscious Healthy Home? Did someone refer you?
Next Steps
We will review your application and respond within 48 hours. If qualified, you will receive an email with a booking link for a complimentary Discovery Call.
How did you learn about us?
Conference/Summit
Oranization/Affiliation
Podcasts
Internet/Social Media
Media/Magazines
Doctors/Providers/Colleagues
Should be Empty:

Conscious Healthy Home™ Client Application

Project Scope

Budget

Property Details (if building, renovating, or remediating)

Current Concerns

Project Goals

Investment

What else do you think we should know?

Next Steps