Trash Friends Intake Form

Trash Friends Intake Form

If you are requesting a cleaning of a non-residential space such as a salon, commercial space, art studio, etc., or if you are interested solely in a non-cleaning service such as decluttering, organizing, handy services, donation pick-ups, or body doubling, please instead email us at Chicago@TrashFriends.com with any relevant photos and information. If you are a current client requesting service at the most recent address on file for you and no major information such as name, pronouns, or state of the home has changed, please instead fill out this form: https://form.jotform.com/TrashFriends/RebookingForm
Name (we do NOT need your legal name- please enter the name you like to use)

First NameLast Name
Pronouns
Cell Phone Number
Please enter a valid phone number.
Trash Friends does NOT send marketing texts; However, we do our scheduling through text and send text appointment reminders.
I would like to receive updates by text. Messaging frequency varies. Message and data rates may apply. You can opt-out at any time by replying "STOP" Privacy Policy: https://www.openphone.com/policies/OR9lWzA2pU

Yes
In what neighborhood or suburb is the home you would like serviced located?
Address of Home You Would Like Serviced

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name on buzzer or buzzer code
Trash Friends does NOT send marketing emails and will only email you if you specifically request it or if your phone number appears to be incorrect; People do frequently mistype their phone numbers, so we do highly recommend you leave an email so we have an alternative way of contacting you to schedule your appointment, if needed.
Email
example@example.com
My home is:

Very cluttered and/or extra messyFairly tidy and unclutteredA depression nest (lots of trash, dirty dishes, and general mess)
I would like a:

General CleaningDeep CleaningMove-in/Move-out CleaningCrisis Cleaning (intensive clean of a hazardous/unhealthy home enviroment)Pre-Inspection Cleaning (needs completed by a deadline to avoid penalty)OCD Contamination Cleaning (cleaning to help relieve intrusive thoughts)Trauma-Informed Cleaning (recieving cleaning services is emotionally challenging)Other
Are you particularly sensitive to scents?

YesNoOther
Please list the *accurate* number of bedrooms and bathrooms in your home, as would be listed on a property listing; We are *not* asking which rooms you would like cleaned, or if additional bedrooms are being used for alternative purposes- there is a seperate field for that information. We are simply accessing the overall size of the home.
Number of bedrooms (please include additional "bedrooms" used for other purposes such as an office, and any additional bedrooms in the basement you would like cleaned; We do not need to know the purpose of the additional bedrooms, just the total number of "bedrooms" in the home)
Number of bathrooms (including bathrooms in the basement if you would like them cleaned)
Do you have an unfurnished basement you would like cleaned?

YesNo
How many staircases in your home would you like cleaned? If none, skip or enter "0". Please do not include any staircases in common areas of your building that you do not wish to be cleaned during your service.
If you want all rooms in your home cleaned, you may simply leave this field blank. If you would like only specific areas of your home cleaned, please specify in this field.
My home is a:

Multi-level homeSingle-level homeDuplex/3-FlatApartment/Condo
How long have you lived in your home?
How frequently would you like cleanings?

WeeklyBiweekly (every two weeks)MonthlyAs neededJust this one timeOther
Do you plan to be at home while the cleaner is present? (You are welcome to stay, if you would like, but you are not required to; Some of our employees have social anxiety and like to have time to mentally prepare before social interactions.)
Do you have any pets?

Dog(s)Cat(s)Bird(s)Rabbit(s)Snake(s)Spider(s)No pets live at the service locationOther
Do you have an unusually large amount of pets, or are you hoarding animals in your home?

YesNoOther
Has it been more than 3 months since you’ve had a thorough cleaning?

YesNo
Would you like any ad-ons?

Cleaning *inside* the refrigeratorCleaning *inside* the ovenInterior window cleaningDusting ceiling fansLaundry (on-site)Laundry (off-site)Cleaning inside the washer & dryerDishwasher interior & filterCleaning inside empty drawers and cabinetsClean scuffs off walls (please note- some cannot be removed & must be painted)Clean under couch cushionsChange sheets/make the bed(s)Clean out litter boxOther
Do you currently have any infestations?

RatsMiceCockroachesFliesFruit fliesAntsTermitesMothsSpidersCurrently have bedbugsHave been treated for bedbugs in the last 30 daysOther
Are there high levels of mold in your home?

YesNo
Are there high levels of dust in your home?

YesNo
Do you have a vacuum the cleaner can use? (Roombas do not count)

YesNo
Do you have a toilet scrubber brush?

YesNo
Would you like your cleaner to wear an N95 mask in your home?

YesNo
Do you smoke tobacco products in your home?

YesNoOther
Do you currently have, or over the course of your cleaning schedule expect to have heavy garbage, or a large amount of garbage that needs to be taken out?

YesNoUnsure
Are any of the following elements present in your home or in areas that you would like to have cleaned? (Please select all that apply; No shame- we will still service you- we will just need to send specific people for the job)

Human waste (feces, urine)Human vomitHuman bloodDead animalsSubstantial amount of pet waste (feces, urine)Substantial amount of mouse/rat droppingsBiting or stinging insects
Do you have human waste (human urine, human feces) in your home? (Absolutely no shame- we will still service you- it just requires materials our cleaners do not carry by default)

YesNo
Are there any dead animals in your home?
Is there any structural damage to your home, or are any utilities (toilet, sink, lights, etc.) not working? If so, please describe:
Do you have a gun in your home?

YesNo
Due to the state of my home, I am currently at risk of (select all that apply):

Being evictedHaving my children taken away by Child Protective ServicesGetting a visit from Child Protective ServicesGetting a visit from Adult Protective ServicesBeing reported to Adult or Child Protective Services, or other agenciesHaving my unit inspectedNot being allowed to return home from the hospital or other care facilityRecovering from surgery or other medical procedure in an unclean environmentNeeding repairs done in my home and being unable to allow maintenance inside
If you have a set date or tentative time frame for a possible eviction, visit from CPS or APS, inspection, or any other deadline for any of the scenarios listed above, please enter the date or time frame in the field below; If the date is within 7 days, please also list the specific time of day of the deadline, if one was given. If none of the scenarios listed above apply, simply leave blank.
Are you interested in any of our other services?

DeclutteringOrganizingBody DoublingDonation Pick-UpHandyqueer ServicesCarpet CleaningUpholstery CleaningDigital Decluttering (emails, etc.)Document ShreddingCar DetailingPacking/Unpacking HelpEnergetic CleansingWelfare Checks & Saftey ServicesPersonalized Private Cleaning LessonPersonalized Cleaning/Organization SchedulePersonalized Organizational Method RecommendationsFREE Trash Talk Support Group for Hoarding & Related Behaviors (non-theistic)Pet Care
Please indicate in this field if you would like to also set up, or learn more about, any of our additional services at this time, or are only expressing potential future interest:
Do you have a specific deadline by which you would like the cleaning completed?
Are there any days/times that work best for you?
Are there any days/times that do NOT work?
Are there any days/times that work best for you, or days/times that do NOT work?
Do you have any time or budget constraints? (For instance, if you want the cleaner to be done by 10pm, or if you have only budgeted for a set number of hours; Please keep in mind, cleaning services are $50/hr, and some additional services available have higher rates)
What are your priorities for the cleaning?
What is the parking situation? (Do you have a parking lot the cleaner can use, do they need a permit to park in your neighborhood, paid parking, free parking, etc.)
Please choose the one which best describes your home:

Entry to the home is at ground levelEntry to the home is slightly above or below ground levelI live in a walk-up buildingThere is a reliably operating elevator in my building
If you live in a walk-up, how many flights of stairs is it to your unit?
Many of our employees have experience working in other various mental health roles; If you work in mental health, and do not want to risk that the employee performing your service may be someone you know professionally, please indicate in this field and we will send an employee who does *not* have previous professional experience in the mental health field.
Anything else we should know?
Anything else we should know?
While we do not require photos, we highly recommend sending them in order to provide a more accurate estimate. Photos will never be used or shared, and will only be viewed by upper management, and the specific worker(s) that will be performing the job. Wide shots of each room, the stovetop, bathtub(s)/shower(s), and any particular area(s) of concern are best to send. If you are requesting a refrigerator cleaning, please also send a photo of the inside of the refrigerator.

Cancelof
Would you potentially be willing to let us take before/after photos and/or cleaning videos? (You would remain anonymous and nothing potentially identifying would be included)
How did you hear about us?

Word of MouthChicago Queer ExchangeFacebookInstagramLexFlyerChicago ReaderFutureU Self-Care SummitA therapist or outpatient programYelpOther
If you were referred by an employee, current client, or partnering business, please tell us who!
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