New Client Questionnaire SharePinTweet+1Share Contact InformationYour Name* First Last The primary contact for the project.Mobile Phone*Home PhoneOffice PhoneEmail* How would you prefer to be contacted?*Phone callsText messagesEmailsCurrent Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Is the Project Address the same as your Current Address?*YesNoProject Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Will your partner or spouse be involved in the project?*YesNoSpouse's Name First Last Your spouse's name.Mobile PhoneOffice PhoneEmail Please list at least three times in the next two weeks that would be convenient for you to be contacted via phone about your project.*Who is responsible for project decisions?MyselfMy SpouseWe will decide together.Have you ever hired an interior designer before?*YesNoPlease describe your experience.How did you hear about us?*Client ReferralHouzzGoogleVendor ReferralOtherWho referred you?Please elaborate.About the ProjectWhy are you looking to design or redesign your space?*Project Type* New Construction Remodel Design/Decorating Other Please select all that apply.Please elaborate on "Other".Do you have an architectural plan of your home?*What best describes the ideal timeline for your project?*As soon as possible.Within three months.Three to six months.Rooms Included in Your Project* Entry Hall/Foyer Living Room Dining Room Master Bedroom Kitchen Family/Great Room Entire Home Nook Office/Study Laundry Area Powder Room Guest Bedroom Master Bathroom Hall Bathroom Children Bedroom(s) Home Theater/Media Room Lower Level/Basement Outdoor Area Other Please check all that apply.Please list additional rooms to be designed.Enhancements Being Considered* Furniture and Space Planning Flooring Cabinetry and Countertops Interior Paint and Wallcoverings Artwork, Accessories and Styling Lighting Window Treatments Plumbing Fixtures Window Replacements or Changes Appliances Reupholstery Exterior Paint Please check all that apply.Room by Room Enhancements*Please talk us on a walk through of the rooms you are looking to enhance and tell us what about each of them you would like to change. E.g. "I would like to change the fireplace built-ins in my great room". Overall Project Budget*Less than $10,000$10,000 - $20,000$30,000 - $50,000$50,000 - $100,000$100,000 - $250,000$250,000 - $500,000$500,000 +Room by Room Budget*Please break down your overall budget by what you would like to invest for each room of your project.Which of the following describes your style?* Classic and neutral but also a little bohemian Theatrical, unconventional yet spare and modern Laid-back, glamorous and traditional, but with a twist Traditional, elegant, classic Modern and neutral with a gentle feel A mix of traditional and modern elements Collected, eclectic, worldly, but not scattered Please check all that apply.Colors You Like*Colors You Don't LikeWhat is your favorite room in your home?*Why?What don't you like about your current home?*What part of your home do you use the most?What part of your home do you use the least?How long do you plan on staying in your current home?*Less than five yearsFive to ten yearsTen to twenty yearsForeverAre there any existing pieces of furniture or collections that must be incorporated into the new plan?*YesNoPlease explain.Do you need sun control from your window treatments?YesNoPlease select the following technical needs associated with the project scope. Computers Wireless/DSL/Cable Home Theater/Surround Sound Music Other Check all that apply.Have you engaged with a contractor or builder?*YesNoName of Contractor or BuilderYour FamilyList Household Members and Any Specific Requirements*Are there any physically challenged or elderly people living in the home?*YesNoPlease elaborate.Household Pets and Special ConsiderationsYour LifestyleOur entertaining style is... Formal Informal Combination/Both Please check all that appy.Average Number of Guests1-67-12More than 12Entertaining Preference Sit-down Meals Buffet-style Meals Watching TV/Movies Games/Cards Music Please check all that apply.Do you have any hobbies/interests we should consider when designing your space?Do you need an area to accommodate your hobby?Additional InformationLink to Your Houzz Profile or Ideabook Link to Your Pinterest Inspiration Board or Profile Page Is there anything else we should know? SharePinTweet+1Share
