Current Situation Assessment:

Are you addressing immediate accessibility needs or planning for the future? *

IMMEDIATE

FUTURE

What daily activities are currently challenging for you in your home? *

Falls or near-falls

Tripping hazards

Slippery surfaces

Poor lighting

Difficulty reaching items

Navigation obstacles

Movement & Access:

How do you move around your home?

Independently

with aid

with assistance

Do you use any mobility devices?

Wheelchair

Walker

Cane

Other...

Are doorways wide enough for comfortable passage?

Yes

No

Are there level changes between rooms that cause difficulty?

Yes

No

Key Living Spaces

Main Level Layout:

Are your essential rooms (bedroom, bathroom, kitchen) on the main level?

Yes

No

Even if on the same level, are any essential rooms difficult to reach due to distance or layout?

Yes

No

Laundry Access:

Where is your laundry located?

Is it easily accessible considering both location and distance

Yes

No

Safety & Comfort Concerns:

Have you experienced any of these safety issues:

Falls or near-falls

Tripping hazards

Slippery surfaces

Poor lighting

Difficulty reaching items

Navigation obstacles

Where do these issues occur most often?

Bathroom Specifics

Which bathroom activities are challenging:

Entering/exiting the bathroom

Using the shower/tub

Using the toilet

Reaching the sink

Maintaining balance

Other...

Project Specifics:

What is the total square footage of the home?

0-500sqft etc

Which specific areas need renovation:

Bathroom

Kitchen

Bedroom

Entryway

Multiple rooms

Do you have financing in place?

Yes (specify type: Cash/Loan/Grant)

No, need financing options

No, would like information about assistance programs

Priority Modifications:

Which features would most improve your daily life:

Zero-step entry

Wider doorways

Grab bars

Barrier-free shower

Better lighting

Accessible kitchen features

Smart home technology

Project Scope

Budget range

Under 10,000

10-25k

25-50k

50-100k

100+

Timeline preference

What is your intended timeline for starting and completing the remodel? *

As soon as possible

3-6 Months

6-12 Months +

Just Gathering Info

Quality level desired

Quality level desired

Economy

Standard

Premium

Additional Considerations:

Will caregivers need accommodation?

Yes

No

Are there specific medical conditions influencing your needs?

Do you anticipate changes in your needs within the next 5 years?

Where can we send your Audit Estimate?

First Name *

Last Name *

Email *

Phone *

For the most accurate estimate, please provide your address

Address *

Address *

City *

State *

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Country

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