Client Intake Form
Clean Slate by Aliyah
First & Last Name
*
Phone Number
*
Residential Address (Cleaning Location)
*
What type of service are you requesting?
*
One-time deep clean
Standard recurring clean
Move-in / Move-out
Other
How often are you interested in service?
*
Weekly
Biweekly
Monthly
One-time
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Number of bedrooms
Number of bathrooms
What kind of flooring is in the home?
How would you describe the current condition of the home?
*
Light cleaning needed
Moderate buildup
Deep cleaning needed
Hoarded / Clutter-heavy areas
Are there any areas that need extra attention?
*
Are there any areas that are unsafe or should not be accessed?
*
What are your top priorities for your home cleaning?
*
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What is your cleaning preference?
*
I want you to bring cleaning supplies.
I want you to use my cleaning supplies.
Are there any allergies or sensitivities to cleaning products or scents?
*
Is anyone in the home immunocompromised or sensitive to chemicals?
*
Yes
No
Not sure
Are there any pets in the home? If so, what kind?
*
Any products you prefer NOT to be used?
*
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Continue
Continue
How can I access the home?
*
Someone will be home
Lockbox / code
Key pickup
Other
Is parking available? Please share any instructions I should know.
*
If you were referred, please list their name here.
Is there anything else you want me to know before your appointment?
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Signature
Should be Empty: