Free Consultation with Dwellness

Free Consultation with Dwellness
This Questionnaire collects basic information about you and your home to inform your Free 20-minute Consultation with Geeta at Dwellness.

It will take less than 5 minutes to complete the Questionnaire. Press the [Submit] button when you're done.

Thank you for choosing Dwellness.© 2024 Dwellness.

For permissions and questions contact info@dwellness.com.au
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
What are your goals for the Free 20-minute Consultation? Select all that apply.

I would like information about your home assessment servicesI would like information about your coaching programI would like information about your productsI have a sick child and need advice about how a healthy home can assist recoveryI need referral to a mould remediatorOther
What Dwellness service are you interested in?

On-site Mould and Moisture AssessmentOnline / remote consultationBuilding design serviceDon't knowNone
In what era was your home built?

Before 19501950 to 19701971 to 1990After 1990
Have you experienced any of the following in your home? Select all that apply.

Ground level floodingRoof leakMajor storm damagePlumbing or appliance leakWaterproofing failureHouse fireDrug use / drug labDon't knowNone
Are you or other members of your household experiencing health issues that you think may be related to your home?

YesNoDon't know
What environmental hazards are you concerned about in your home? Select all that apply.

MouldElectromagnetic fields (EMF)Toxic chemicalsTraffic related air pollutantsHeavy metalsCockroachesHouse dust mitesVirusesBacteriaBlue lightDon't knowOther
What is your main concern about your home environment. Please describe your situation as clearly as possible.
How did you hear about Dwellness?

Referral from healthcare providerReferral from friend/associateListing on Australiasian Society of Building Biologists websiteInternet searchDon't knowOther
Would you like to be included on our mailing list?

YesNo
Should be Empty: