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Exit Survey
 
 
Hello: You are invited to participate in our client survey Intake Form. Potential clients will be asked to complete a survey that asks questions about design preferences. It will take approximately 5 - 10 minutes to complete the questionnaire. Your participation in this assessment is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions and preference. Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Kaneisha Page at 571-216-0997 or by email at [email protected]. Thank you very much for your time and support. Please start with the survey now by clicking (I Agree) box below.
 
 
 
 
* Do you reside in an Apt or house?
 
Apt
 
House
 
 
 
* Do you have hardwood or carpet?
 
Hardwood
 
Carpet
 
 
 
* Decor Theme (Please Select One)?
 
 
 
* What room would you like serviced (Select all that apply)?
 
Living / Family Room
 
Nursery / Kids Room
 
Dining Room
 
Bedroom
 
Bathroom
 
Other

 
 
Preference for the following:
Very Preferrable Suitable Not Preferable
* Paint (Colors)
* Area Rugs
* Window Treatment
* Storage
 
 
Preferable Accent Furniture:
Wall Art Accent Table Storage Ottaman Floor Mirror Lighting
* Not At All
* Neutral
* Must Have
 
 
 
* Do you have a Budget?
 
$100 - $500
 
$500 - $1,200
 
$1,200 - $5,000
 
 
Contact Information
* First Name : 
* Last Name : 
* Phone : 
* Email Address : 
 
 
 
Additional Comments/Suggestions:
   
 
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