Getting to Know You
Please complete as accurately and detailed as possible to ensure we have a full picture of how we can help you reset your lifestyle.
Client Information
Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Home Street Address
Home Street Address Line 2
Home City
*
Home State
*
Home Zip Code
*
Preferred Method of Communication
*
Phone
Text
Email
Please specify all days of the week and times of the day you are available for a consultation call:
i.e Mondays at 6PM, Thursdays at 2PM, etc.
Household Information
Number of Adults in Home
*
Number of Children in Home
*
Pets (Type and Number)
Household Members with Special Needs / Allergies / Medical Conditions
*
Yes
No
If Yes, Please Explain
Services Requested
Household Management
Organization
Inventory Management
Errands
Scheduling
Other
Home Maintenance
Cleaning Oversight
Vendor Coordination
Repairs Coordination
Seasonal Prep
Other
Personal Assistance
Calendar Management
Travel Planning
Shopping Assistance
Concierge Support
Other
Family Support
Childcare Coordination
New Mom Services
School Communications
Activity Scheduling
Meal Planning
Other
Other Services Requested
Home Access Information
Will the Lifestyle Manager require access to your home?
*
Yes
No
Preferred access method
Key
Lockbox
Smart lock code
Remote entry
Other
Special instructions for home access
Important Household Information
Preferred Service Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred Service Hours
Important Contacts
Client Goals
Your Goals
Work-Life Balance, More time with family, Travel, etc.
Your Specific Concerns or Priorities
Additional Intake Questions
Biggest Challenges in Managing Household
Tasks That Would Make the Biggest Difference if Delegated
Household Routines or Preferences
Anything Else You Would Like Us to Know
Submit
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