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    Primary Contact Information

    Name *

    Address *

    City, Zip Code *

    Phone

    Email

    Household Information

    House Square Footage

    Age of House

    Number of Bedrooms

    Number of Bathrooms

    How long have you lived in your home?

    How long do you plan to live in your home?

    Do you have plans for the future use of your residence? Will your rooms need to serve different functions in the future for any household members?

    Household Members

    Please list names and ages

    Do you anticipate changes for any household members within the next 2-3 years? (College, retirement, etc.) Please explain.

    Do you have pets in the household? If so, please list type of pet, age, and special needs.

    Special Considerations (check all that apply):
    DisabledElderlyYoung childrenDaytime sleepers

    Entertaining

    Our entertaining style is:
    FormalInformalCombination or Both

    We entertain:
    1-2 times per week1-2 times per month1-2 times per year

    Average number of guests:
    1-67-12More than 12

    Average age of guests:
    AdultsTeenagersChildrenAll Ages

    Types of entertaining (check all that apply):
    MealsMusicGamesWatching TVOther

    Hobbies & Activities

    Usual activities (check all that apply):
    ReadingT.V. / Home TheaterCrafts / SewingArtEntertainingMusicSportsCookingOther

    If you need areas to accommodate hobbies, please explain.

    What are your technical needs? (Check all that apply):
    ComputersSurround SoundWirelessDSL / SatelliteHome TheaterOther

    Are you looking to create a children's play area?
    YesNo

    Home Office

    Do any household members work form home?
    YesNo

    Is there a designated area for working in your home?
    YesNo

    If yes, are there any special needs (i.e., lighting, soundproofing, computers, etc.)?

    Project Information

    Person(s) responsible for project decisions:*

    What is the budget for your project?*
    $2,500 - 4,999$5,000 - 9,999$10,000 - 29,999$30,000 - 99,999$100,000 - 200,000Other

    This project is to be done:
    All at one timeIn Stages

    If the project will be done in stages, please indicate the order of the work:

    Will occupants be home during the project/construction for access?
    YesNo

    If not, will you authorize neighbors or designer to provide access?

    Priorities:

    Which rooms are to be included in the project? (Check all that apply):*
    Entry Hall / FoyerFormal Living RoomFormal Dining RoomMaster BedroomMaster BathroomBedroom #2Bathroom #2Bedroom #3Bathroom #3Office / StudyHallFamily / Great RoomLaundry AreaHome Theater / Media RoomNookOutdoor KitchenOutdoor Living AreaOther

    What kind of enhancements are you considering? (Check all that apply):
    FurnitureRemodel KitchenWindow replacements or changesInterior paintExterior paintWallpaperWall finishesFlooringWindow treatmentsArtwork, mirrors, etc.AccentsSpace planningMuralsColor scheme / PaintReupholsteryRemodel bathroomAppliancesPlumbing fixturesRoom additionLighting

    What is your favorite room in the house and why?

    What don't you like about your current home and why?

    What part of your house do you use the most?

    What part of your house do you use the least?

    Are there any pieces of furniture, window, wall or floor coverings that must stay and be worked into the new plan? Please explain.

    Are there any items that MUST GO? Please explain.

    How involved do you wish to be in this project?
    Very involved (Call you with details and updates daily or weekly)Involved -- Designer to act as project manager (Keep you updated with install dates, deliveries, work schedule, etc.)Minimally involved -- don't call until everything is ready to install

    What is your "ideal" timeline for your project?
    4 - 6 weeksWithin 3 months3 - 6 monthsOther

    Design Goals

    Prioritize the following personal design goals for your home in order of importance:

    A) More stylish/beautiful in appearance
    B) Function more effectively for my household
    C) Better reflect my/our personal tastes
    D) Other. (Please explain)

    If you would like to include "green products" when possible, please specify:

    Design Preferences

    What "feeling" are you seeking to achieve?
    CasualFormalSpaciousClean linesWarm / CozyLight / AirySophisticated'Lived in'WelcomingRomanticContemporary

    What style are you seeking to achieve?
    TuscanBeach CottageOld WorldMediterraneanCountry CottageArt DecoFrench CountryAsianEarly AmericanMission StyleSouthwesternIndustrial

    If relevant, do you and your partner's style preferences agree?
    YesNo

    Comments

    Fabric Preferences (Check all that apply):
    PaisleySheerSubtle PatternStripeLeatherSatinPlaidBold PatternCottonToileSuedeSilkVelvet

    Color Preferences (Check all that apply):
    WhitesBlacksBurgundiesPinksAquasMint GreensOlive GreensForest GreensTealsOrangesRedsNavy BluePowder BlueWarm ColorsCool ColorsSubtleBrightBluesJewel TonesNeutralsEarth TonesPale YellowsYellowsPeachBoldPastelsGraysBeigesTansEggplantLavendersPurplesGreens

    What are the colors you dislike?

    If you have a color theme in mind, please describe it.

    Flooring Preferences (Check all that apply):
    HardwoodNatural StoneCombinationCarpetConcreteBambooLaminateTileCork

    Window Treatment Preferences (Check all that apply):
    Custom DraperiesShuttersAll FabricsShadesBlindsRoom DarkeningSheersCurtainsMetalCombinationOther

    Do you need sun control or privacy with your window treatments?
    YesNo

    Have you ever hired an interior designer before?
    YesNo

    If yes, when did this take place, and were you pleased with the results?