Welcome to Balance By The Bay Pre-Consultation Questionnaire

This brief form helps us customize your consultation experience. Your responses remain completely confidential.

Need a PDF version? We're happy to email one to you.

We appreciate you taking a few moments to complete this.

Name

First Name

Last Name

Date of Birth

YYYY

Phone

Country

(###)

###

####

This is only used to communicate about your consultation.

Name of Spouse or Partner (if living with you)

First Name

Last Name

Their Date of Birth

YYYY

Address of Home (For Consult or Property Assessment)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Year The Home was Built (Date of Construction)

(Example: 1980)

Do you rent or own the home?

What is the approximate square footage?

(Example: 2450 sq feet.)

Are you currently living in the home?

If you are living in the home, how long have you lived there?

(Example: We have lived here since March 1, 2022.)

Have you noticed any changes in your life, positive or negative, since moving into the home?

(Example: My husband lost his job shortly after moving into the home.)

Has there been any major remodeling done (that you know of)? What was done?

(Example: Yes, in 1986 the added an extension to the back of the home.)

Any others living in the house with you (aside from the ones listed previously)? If yes, please include name, relation, age.

(Example: John, son, 16)

Any pets living in the house?

(Example: Yes, 2 dogs and a cat)

Do you find that you like some rooms more than others? Which ones?

(Example: Yes, we use one of the bedrooms to watch TV.)

Do you dislike certains areas or rooms of the home? Please specify.

(Example: Yes, for some reason I don't like the bedroom to the NE on the second floor.)

Are you aware of any positive or negative things that have happened in your home?

(Example: Yes, we have had a number of injuries on the stairs.)

What are the primary area(s) of concern (if you feel like sharing prior to the consultation)?