Non-Toxic Home Questionnaire (E/S)

Name

First NameLast Name

Email

example@example.com

How old are you?

What would you consider to be your major concern?

If you have had a reaction to home products (cleaning supplies, furniture, mattresses, cookware, bedding, air fresheners, flooring, carpet, rugs, tap and bottle water, poor air quality, etc.) please tell me more about what products and what happened.

Safe Alternatives:

A. Cookware and Kitchen Products

Stainless steel
Cast Iron
Pure Ceramic
Glass

B. Flooring

Hardwood
Bamboo
Organic Cotton Carpets
Wool Rugs

C. Mattresses, Bedding & Furniture

Organic Latex
GOTS-certified organic cotton
Untreated Wood
Natural Fiber Pillows

D. Water

Reverse Osmossi
Whole House Filtration

E. Air Quality

HEPA Filters
Carbon Purifiers
Negative Ion Generators

F. Plants

Removes Toxins
Purify Air
Boost Oxygen
Improve Sleep Quality
Improve Indoor Air Quality
Neutralize EMFs