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1) How old is your home? Is it historically important? Any special architectural features? Are you in a historic district?
   
 
 
 
How long have you lived here?
   
 
 
 
How many people live here?
   
 
 
 
Is anyone elderly or handicapped? Are there adequate access /mobility areas for their needs? Emergency exits in place? Please let us know if you have concerns here.
   
 
 
 
Does anyone have any chronic illnesses?
   
 
 
 
6) What kind of heating/cooling system do you have?

 
___Forced Air
 
___Baseboard
 
___Oil
 
___Gas
 
___Electric
 
___Central Air
 
 
 
Are the systems maintained regularly? How about the chimney/flue?
   
 
 
 
8) Do you have?

 
___Well
 
___Septic
 
___City
 
___Sewer
 
 
 
Do you have blueprints of your home?
   
 
 
 
Do you have any environmental concerns regarding your home? Please check -
 
__Air Quality
 
__Carbon Monoxide
 
__Radon
 
__Water Quality
 
__Waste plumbing (clogs a lot)
 
__Mold/Mildew
 
__Electrical
 
__Structural
 
__Paint/lead
 
__Allergens
 
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