Engage Haven Hills
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
How Can Haven Hills Serve You?
*
New Build / Remodel Design Package
Professional EMF Assessment Package
Education / EMF Meter Training / DIY Support
Interview/Podcast/Speaker Request
New Build / Remodel Design Package
What Stage Is Your Project In?
*
Dreaming / Ideating
Hiring Professionals (Healthy Home Consultant, Architect, Builder, MEP Contractors)
Design/ Design Iteration
Site Prep or Foundation Work
Framing
MEP Roughing-Ins (Mechanical, Electrical, Plumbing)
Interior Finishes
MEP Trim Out
Move-In
Do You Have A Healthy Home Consultant?
*
Yes
No
Name of your Consultant
Describe the Goals of Your Build/Remodel:
Do you have a budget of at least $4,000 for professional EMF services?
*
Yes
No
Professional EMF Assessment
Size of the Building?
*
Square Feet
Year Built?
*
Number of Bedrooms
*
Please Select
1
2
3
4
5
6
7+
Property Zip-Code
*
Please share any specific EMF concerns you have with this property?
Do you have a budget of at least $2,000 for professional EMF services?
*
Yes
No
Education
What Type Of Education Are You Looking For?
*
EMF Primer (~1 hour)
EMF Meter Training
DIY EMF Assessment Support
Group Training
1:1 Personalized Training
How Familiar are you with the following EMF Types:
Radio Frequency
*
1
2
3
4
5
Magnetic Fields
*
1
2
3
4
5
Electric Fields
*
1
2
3
4
5
Dirty Electricity
*
1
2
3
4
5
Ionizing Radiation
*
1
2
3
4
5
What EMFs are you interested in learning about?
*
Radio Frequency (RF)
Magnetic Fields (Mag)
Electric Fields (E)
Dirty Electricity (DE)
Ionizing Radiation
Other
What is your learning style?
*
Reading
Listening
Watching
Doing
Do you own your own EMF meters?
*
Yes
No
What meters do you own?
Have you budgeted a minimum of $600 for EMF education?
*
Yes
No
Have you budgeted a minimum of $275 for EMF education?
*
Yes
No
Interview/Podcast/Speaker Request
Please describe the engagement request:
*
Where can we view your content?
*
Link to: Website, Social Media Page, Podcast, Event Page, etc.
Type
*
Remote
In-Person
When would you like the engagement to occur?
*
-
Month
-
Day
Year
Date
How large is your audience?
*
What topics would you like covered?
*
Any other information to share?
Submit
Submit
RefSource
Qual1hrPaid
No
Yes
Qual15min
No
Yes
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