Name
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First Name
Last Name
Email Address
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What is the best phone contact number?
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Location (Charlotte region) or elsewhere?
In some cases we can arrange on-site assessments outside of our Charlotte region. If not, you may opt for on phone consults or remote assessment below.
I am interested in having a pre-paid phone consultation
If NOT in our local area: Once you fill out the form below we can set a time for FREE preliminary phone call to discuss details and options on consultation services and pricing.
I am interested in having a remote live-guided assessment
If NOT in our local area: Once you fill out the following questions we will have a quick phone session to discuss details of the process. If we agree to proceed we will then send you some basic equipment to facilitate the assessment process with a security deposit and return label. Assessment will be scheduled and will be live, on camera (FaceTime or Skype). More details later.
Referral
How did you hear about us? Have you been referred by your physician or practitioner? HVAC contractor, remediation contractor, another one of our clients? If so, whom?
Home or Building Description
Home? Work building? Single-family, apartment etc.
Do you own or rent/lease?
What is the square footage of your space?
What year was home or building built?
When was your home built? How many years have you lived there?
How long have you lived in home or occupied building?
Do you have installed carpeting? If so, how old is it and where is it?
Type of Foundation?
What is your foundation? Slab, crawlspace, basement unfinished or finished? If basement, does anyone occupy that space as office or bedrooms?
Do you live near a pond, lake, stream or other water source?
HVACs
How many HVAC units does your home have? What zones do they supply? How old are they? Have the ducts ever been replaced or cleaned? If so, describe. Do you get regular HVAC servicing?
Filters
Where are the filters for your HVAC units? ie central filter on handler or filters at each return? What type or rating are they? Do you replace them regularly or do you have a service company replace them?
Humidity
Have you ever noted the home to be humid or clammy damp especially in the summer? Do you have a humidity monitor? What is the humidity in the summer months on average?
Do you have an attached garage, utility room or shed?
Do you park vehicles or gas-powered equipment in garage or attached storage?
Visible Mold Growth?
Have you ever seen mold or suspected mold growth on any surfaces in the living space or on any furnishings, clothing, shoes, other items? If so, describe in detail.
Have you had renovations performed? If so, what?
Have you had previous inspections or testing?
Was the home inspected when it was purchased or since then? Do you have any reports of water intrusions or moisture issues, mold growth etc. If so, were they repaired and by whom. What was done if mold was found?
Leaks, Intrusions?
Have you had any flooding, water leaks, HVAC drain back-ups, roof leaks, crawlspace or foundation puddling, overflows of sinks tubs toilets or washer? If so, describe IN DETAIL where they occurred, what areas were impacted, and indicate what was done to mitigate them.
Have you done any DIY testing such as ERMI or HERTSMI-2?. If so, when and where did you collect the sample(s) from?
Do You Have Indoor Pets?
If so, please detail. If pets have a history of urinating in the home it is important for us to know this due to some inhibiting factors that can skew results for specialized testing.
Complaint Areas
Are there any areas you have noted to be musty or odd smelling? Are there any areas where your symptoms or other occupant symptoms seem to be worse? Are there areas you or sensitive occupants feel best?
Symptom History
Do you have symptoms that started in this home, if so when? Describe.
Symptom Patterns
Do any symptoms tend to worsen at home and lessen when away for a while? If so, describe. Does it make a difference in symptoms if the HVAC is running or off?
Seasonal
Are symptoms seasonal? If so, describe.
Previous Homes
Have you had previous homes with mold, mustiness, water leaks or possible mold exposures? If so, describe.
Furnishings and Personal Items
If you had water damage or mold exposure in previous homes did you bring any furnishings or other items to this home from that home? If so, describe and were they professionally cleaned?
Work Environment
If you work away from home have you noted any symptoms at work or any indications there may be mold or chemical exposures?
Sensitivities
Do you or any family members experience sensitivities to fragrances, other odors, chemical cleaners, etc. Is this in the home or do you experience this in other buildings too?
Physician Involvement
NOTE: the following form questions are not HIPAA compliant.
Are you or a family member under the care of a physician who has indicated you have mold-related illness or symptoms? If so, have you had lab testing to verify? If so, describe.
Treatments
Are you or a family member under any specific treatments for mold or bio-toxin illness, CIRS, Lyme or auto-immune disorders?
Improvements
Have you or any family members under treatment been experiencing improvements in symptoms and clinical testing?
Other
If you are have not been verified or tested for mold-related illness can you describe symptoms you or your family members have been experiencing?
Would you allow us to review previous reports or lab testing results you've had done on this property?
