Name

Last Name

Email Address

Phone

Any Pets (type)?

How long have you been in your home?

How long do you plan to stay in your home? How long do you plan to stay in your home? 1 - 5 years 5 - 10 years Never want to move

What do you love about your home?

What is the biggest issue(s) with your home?

What problem(s) would you like to solve?

What is the budget range for your project? What is the budget range for your project? $1,000 - $10,000 $10,000 - $25,000 $25,000 - $50,000 $50,000 - $75,000 $75,000 - $100,000 Over $100,000

Have you worked with an interior designer in the past? Have you worked with an interior designer in the past? Yes No

What made you decide to use an interior designer? What made you decide to use an interior designer? Too many decisions and the process is overwhelming Don’t want to make a mistake I can’t visualize I want something unique that no one else has Want to stay within my budget

Who will be making the decisions by percentage?

When making decisions: When making decisions: I like to see as much as possible and then decide I can make a decision very easily - I know it when I see it I get overwhelmed with choices

How often do you entertain? How often do you entertain? 1-4x annually Once a month As little as possible I would love to have people over as much as possible

What percentage of your shopping is online? What percentage of your shopping is online? 0 - 20% 20 - 50% 50 - 75% Most of my shopping is online

Where do you like to shop? Where do you like to shop? Target Macy's Nordstrom's Galleria/Upscale Mall Boutique Style Shop

What five adjectives describes the way you want your home to feel: