Home Comfort Self Evaluation Form

Home Comfort Pre-Consultation Form

By Magnolia Home Comfort

This 5-minute self-evaluation will get us one step closer to figuring out the best comfort solution for you and your home.

First Name

Last Name

Email

Phone

Address

Do allergy or breathing symptoms seem worse when you’re at home?

Never Sometimes Often Always

Do you experience headaches or fatigue more often when you’re at home?

Never Sometimes Often Always

Does dust seem to return quickly after cleaning?

Never Sometimes Often Always

Have you noticed mold or mildew anywhere in your home?

No Yes Not Sure

Do parts of your home have musty, stale, or unpleasant odors?

No Yes Not Sure

Does your home often feel sticky, damp, or overly humid?

No Yes Not Sure

Do you notice spider webs, insects, or pests in areas that are rarely used?

Never Sometimes Often Always

Are some rooms noticeably hotter or colder than others?

Never Sometimes Often Always

Are there rooms in your home you tend to avoid because they’re uncomfortable?

Never Sometimes Often Always

Do you find yourself adjusting the thermostat often to stay comfortable?

Never Sometimes Often Always

Does your heating or cooling system run frequently without making the home feel more comfortable?

Never Sometimes Often Always

Have you made home upgrades that didn’t fully solve your comfort issues?

Never Sometimes Often Always

Anything else going on in your home you’d like us to take into account?

Upload any additional reference photos / information here.

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