Free Consultation

This questionnaire collects basic information about you and your home to inform your free 20-minute consultation with Geeta at Dwellness. It takes less than 5 minutes. Press Submit when you're done. Thank you for choosing Dwellness.

Name *

First name

Last name

Email *

Phone number *

Where is your home? *

Suburb

State / territory

Postcode

Do you own or rent your home? * Own Rent Looking to purchase Other

Please choose one option.

What type of home is it? * House Townhouse Unit or apartment Other

Please choose one option.

What are your goals for the free 20-minute consultation? Select all that apply. * I have found mould, or suspect it, and want to know what to do next Someone in my household is unwell and I want to know if our home could be a factor I want to understand your services and whether they suit my situation I am buying or moving and want the home checked first I need a referral, for example to a mould remediator I would like information about Calm Lighting products Other

Please select at least one option.

What Dwellness service are you interested in? * Mould and Moisture Assessment with ERMI test Rapid Review online / remote consultation Environmental Health Coaching Case Support for Healthcare Practitioners Don't know None

Please choose one option.

In what era was your home built? * Before 1950 1950 to 1970 1971 to 1990 After 1990 Don't know

Please choose one option.

Have you experienced any of the following in your home? Select all that apply. * Ground level flooding Roof leak Storm related water damage Plumbing or appliance leak Waterproofing failure House fire Drug use / drug lab Don't know None

Please select at least one option.

Are you or other members of your household experiencing health issues that you think may be related to your home? * Yes No Don't know

Briefly, what health issues, and who is affected? Optional, but it helps me prepare for your consultation.

Please choose one option.

What is your main concern about your home environment? Please describe your situation as clearly as possible. *

How did you hear about Dwellness? * Referral from healthcare provider Referral from friend/associate Listing on Australasian Society of Building Biologists website Internet search Don't know Other

Please select at least one option.

Would you like to be included on my mailing list? * Yes, send me occasional emails about healthy home topics. Unsubscribe anytime. No thanks

Please choose one option.

Something went wrong sending your form. Please try again, or email me directly at info@dwellness.com.au.

Thank you

Your questionnaire has been received, and a confirmation is on its way to your inbox. I'll review your answers before your consultation so we make the most of our time together.

If you don't see the confirmation within a few minutes, please check your junk folder.

Geeta, Dwellness

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Free Consultation with Dwellness

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