What is your preferred method of contact?
 Phone       Email

What type of heating system does your home have now?
 Central        Wall        Floor

What type of air conditioning does your home have now?
 Central        Wall

Is your home a 1-story or 2-story?
 1-story        2-story

Are some rooms hotter or colder than others?
 Yes        No

Do you get high utility bills?
 Yes        No

Would you like to lower your utility bills?
 Yes        No

breathing ailments? (select all that apply)

 Asthma  Allergies  Hayfever  Pet Allergies 
 Upper Respiratory Problems  Dry Nose/Throat

Any other comments you wish to add?

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