Primary Contact Information

Name *

Address *

City, Zip Code *



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


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?

Home Office

Do any household members work form home?

Is there a designated area for working in your home?

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?

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


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?


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?

Have you ever hired an interior designer before?

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