BoneClutter LLC Intake Form

BoneClutter LLC Intake Form

We are interested in learning about your professional organizing needs. Please fill out this form and we will get back to you shortly.
Name*

First NameLast Name
If you are NOT the primary recipient of the BoneClutter services you are requesting, please enter the name of the person who is the primary recipient directly below (e.g. your mother is the primary recipient of the BoneClutter services and you are filling this form out for her).
Name

First NameLast Name
Please enter the address of the work location where the organization is needed directly below.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Now, please enter your home or billable address directly below if different from the address listed above.

NOTE: If you are filling this out for a friend or family member who is in need of BoneClutter services and you are the one paying for it, please fill in your home or billable address directly below (if different from address listed above).
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail*
For which of the following 3 categories of organization are you requesting assistance? Please select all that apply.*

Objects - physical items other than paperData - paper files, forms, foldersTime - minutes in a day, hours in a week
How would you best describe the setting(s) or area(s) that need organizing?*

ResidentialBusinessBoth Residential and BusinessOther
If you chose "Other" to the above question, please explain below.
If applicable, how many separate rooms or areas do you need organized?
Please briefly list and/or describe the area(s) that you need organized?

0/500
Time Frame

Within what time frame would you like all organization project(s) complete? Please enter below.
Within how many months, weeks, and/or days would you prefer all organization project(s) to be completed?
Months*
Weeks*
Days*
How often would you prefer service appointments?*

Daily ServiceEvery Other Day ServiceWeekly ServiceEvery Other Week ServiceMonthly ServiceEvery Other Month ServiceOther
If you chose "Other" to the above question, please explain below.

On the following scale from 1-5, please rate how much involvement you wish to have in this organizing process.*

	1 - Barely present and involved while organizing is being done	2 - Somewhat present and involved while organizing is being done	3 - Present and involved about half the time while organizing is being done.	4 - Mostly present and involved while organizing is being done	5 - Always present and involved while organizing is being done.
Your Presence and Involvement

How many people do you expect to be directly involved with the organization project(s)? Please include yourself in the count if applicable.
How many people do you expect to be affected by the organization project(s)? Please include yourself in the count if applicable.
(i.e. children, spouse, business associates)
Learning Styles

Consider the following 3 Learning Styles: Visual - see to learn; Auditory - hear to learn; Kinesthetic - move to learn

According to your preference, please rank the 3 learning styles in the matrix below. Please choose a different number for each style.*

	1 - Most Preferred	2 - Somewhat Preferred	3 - Least Preferred
Visual
Auditory
Kinesthetic

Action Styles

Consider the following 2 Action Styles: Jogger - doing a little bit each session over an extended period of time; Sprinter - doing a lot in one session over a short amount of time.
If you had to choose, which one would best describe your action style?*

JoggerSprinter
Do you have any mental, physical, and/or emotional conditions that I should be aware of as it relates to the organization project(s)?*
If yes, please list and/or describe them below.
In-Person Consultation
BoneClutter LLC offers an initial in-person consultation up to 1 hour (fee waived). Please select your top 3 dates and times below for your consultation session.
1st Choice Consultation Session Date*

MonthDayYear
Time*

:HourMinutesAM/PM Option
2nd Choice Consultation Session Date*

MonthDayYear
Time*

:HourMinutesAM/PM Option
3rd Choice Consultation Session Date*

MonthDayYear
Time*

:HourMinutesAM/PM Option
Please briefly describe the ultimate goal or final result(s) you want to achieve by the end of the organization project(s)? In other words, what are your organizational dreams?
Any final comments or remarks?
Please type your full name. This will serve as your electronic signature.*
Should be Empty:

BoneClutter LLC Intake Form

Time Frame

Learning Styles

Action Styles

In-Person Consultation