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Healthy Home Seminar Registration & Survey

Name:
Contact #:
 
Builder Name:
Site Name:
Phase #:
Lot #:
Model Type:
Plan #:
Preferred Time: AM PM

Weekdays Weekends
 
Please complete the diagnostic survey below. By completing the information below you will be providing us with important information that may improve your homes comfort. You will also receive a $25 Gift Certificate from Pinnacle.
 
How long do you plan on staying in this home?
1-5 5-10 10+
 
How many persons will be living in this home?
1 2 3 4 5 6 7 8 9 10
 
Will children be living in this home?
YES NO
 
Do any family members suffer from allergies, asthma, or other respiratory problems?
YES NO
 
Do you feel any difference when you are outdoors from when you are indoors?
Better Indoors Better Outdoors
 
Do you have any pets?
YES NO
 
Are there any smokers in the home?
YES NO
 
Will this home have hardwood floors?
YES NO
 
Do you have any wood furnishings?
YES NO
 
Will this home have carpeting?
YES NO
 
Please rate level of importance of the following from 1 to 5, 5 being most important.
 
Comfort, consistent temperature
1 2 3 4 5
 
A system that adjusts to my schedule and lifestyle
1 2 3 4 5
 
Improved indoor humidity during warm months
1 2 3 4 5
 
Relief from allergies and asthma symptoms
1 2 3 4 5
 
Increased energy efficiency for low energy costs
1 2 3 4 5
 
Quiet system operation
1 2 3 4 5
 
Minimized cost of future service and maintenance
1 2 3 4 5
 
An environmentally friendly system that exceeds environmental/energy standards
1 2 3 4 5