Conscious Healthy Home™ Client Application
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Project Scope
What services are you interested in exploring?
1:1 Consulting: Consciously Custom™ Package (site selection, design, team vetting, inspection recommendations, etc.)
Whole home renovation and design guidance
Conscious Collective™ Group Membership
Targeted improvements in a specific area
Assistance in finding an existing inventory home
1:1 Consulting: “other” Conscious Strategy Session™ services
Budget
Outside of consulting costs, what is your estimated project budget?
$10,000-$50,000
$50,000-$100,000
$100,000-$500,000
$500,000+
Property Details
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)
Indoor Air Quality
Water Quality
Mold or Moisture/Humidity
EMF
Chemical Sensitivities
Allergens
Lighting and Circadian Rhythms
Other
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.
Availability
We typically begin with a detailed initial consultation. Please indicate your preferred timeframe for your kickoff call:
Within the next week
Within the next month
Within the next three (3) months
Flexible / No specific timeframe
CHH consulting services are conveniently offered after 5pm CT on weekdays and at various times over the weekend so as not to interfere with your work schedule. Does this timing work for you?
Yes, that's great
No, I prefer to work with a consultant between 8am-5pm M-F
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?
Yes, I am fully committed to the success of my project
I am interested by have some time constraints
I do not have the time to invest. I would like someone to make the choices for me and keep me informed
I am unsure about my interest and availability
Our services are best suited for individuals committed to making informed, empowered decisions about their project. Does this describe you?
Yes, I am fully committed to being empowered to confidently make these project decisions on my own behalf
I am interested in services where the decisions are made independently, without much input from me
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. If you have not already researched our services and pricing, please visit (https://www.conscioushealthyhome.com/chhservices)
Yes, I am ready to go
I have financial constraints
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?
Submit Form
Should be Empty: