Questionnaire

Help us understand the problem

Please help us understand the issues you are experiencing. Providing as much information as possible will help us know how to help you best. Once the form is submitted our team will be in touch with you.

Name

First Last

Phone

Address

What health symptoms do you have?

Have you seen a doctor, if so, what was found or what diagnosis was given?

How many other people live in the home and does anyone else have symptoms?

Are there any odors noted in certain locations of the home?

Have there been any water leak events in the homes history? If so, briefly describe the location and how long building materials were moist?

Please briefly describe any rooms in which you have reactions or feel unwell.

Age of structure and how long have you lived there?

How many HVAC units service the property?

Total Square Footage of Home:

How did you hear about us?

Please upload any relevant Videos, Reports, or Lab Results

Drop files here or

Accepted file types: jpg, gif, png, pdg, mp4, zip, Max. file size: 50 MB, Max. files: 6.

If your files are large please contact us directly to make arrangements to get it to us.

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Questionnaire

Help us understand the problem

Contact Us

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843 400 3020

heretohelp@pureindoorenvironmental.com

Suspect an air quality or mold problem?

Serving the Charleston, SC area.

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