Client Intake Form

Office Closed for Vacation: Our office will be closed for vacation from August 7 through September 1. All messages and inquiries will be returned on or after September 1. Thank you for your patience and understanding.

Please note: We specialize in Hoarding Cleanup (Decluttering, Cleaning & Organization), Senior & Elderly Cleaning, and Deep to Heavy-Duty Cleaning Services. We work with clients who are ready to move forward with services, with projects typically starting at $2K–$3K and up. Due to the personalized nature of our services and the scope of these projects, there is currently an approximate wait time of 2–8 weeks.

Customer Intake Form

Responsible Party/Decision Maker *To ensure a smooth booking process, please designate one person as the primary point of contact for all communication, scheduling, approvals, and payment arrangements. If the actual customer will not be managing the booking process, please provide the name and contact information of the person responsible. If you are the customer and will be coordinating services yourself, please enter your own information below.
Customer's Full Name: *The customer's legal name should be listed here. Do not enter the name of a third party or point of contact, such as an attorney, therapist, social worker, family member, friend, or power of attorney.
Address: *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Email: *
Any pets? *please list if any.
Estimated Investment Range ($2000, $3000, $5000, etc.) *Our goal is to set realistic expectations for our clients. When setting a budget, it's important to remember that deep to heavy-duty cleaning and hoarding cleanup takes time. Typically, hoarding clean-up projects require two or more visits (daily/per session). For deep and heavy-duty clean-ups without clutter or hoarding, it takes one or more visits (daily/per session). All cleanings are hourly until completed with a minimum of 7 hours per cleaning/session.
Phone Number: *Please enter digits only. No dashes.
Service Location *
Have we serviced you and or a family member in the past? *
YesNo
Service Type: *
Deep to Heavy Duty Cleaning Dirt Level (*NO Hoarding or Clutter)Elderly/Senior Cleaning Deep to Heavy Duty Dirt Level (*WITH Hoarding or Clutter)Elderly/Senior Cleaning Deep to Heavy Duty Dirt Level (*NO Hoarding or Clutter)Hoarding/Clutter (Deep to Heavy Duty Dirt Level (*WITH Hoarding/Clutter)Rubbish Removal Referrals (*FOR booked clients only)
Home Type: *
HouseStandard ApartmentCondo ApartmentCoop ApartmentDuplex Apartment
Dirt Level: *
Light ----- Spaces which have been maintained by regular housekeeping and has 1 layer of dirt build upMedium - Spaces which have been maintained every couple of weeks or at least once per month and has 2 layers of dirt build up.Deep ---- Spaces which have NOT been maintained by regular housekeeping and has 3-4 layers of dirt build up.Heavy --- Spaces which have NOT been cleaned in months and has 4-6 layers of dirt build up.Heavy Duty -- Areas that have massive amounts of dirt and have not been cleaned in years.
How did you hear about us? *
AngieCrain's New York BusinessFacebookFriendGoogleLawyerReferralMount Sinai HospitalSocial WorkerYahooYelpHealthcare ProfessionalYouTubeOther
Number of Bedrooms *
Number of Bathrooms: *
Floor Type: *
CarpetedNon-Carpeted
Number of Floors *
Two Consultations Must Be Completed: Preferred Q&A Session and Phone Consultation Availability (Dates & Times) *
Preferred Service Date (Based On Availability) *
Infestation/Jobsite Conditions *
Bed Bug InfestationFly InfestationLead PoisoningMice InfestationMold ExposureOdorPest DroppingsRoach InfestationNone of the above
If you are inquiring on behalf of the customer, please provide your name and relationship to the customer (such as a social worker, case manager, family member, friend, therapist, caregiver, attorney, or Power of Attorney representative). *Example: I am her niece, my name is Sara Doe.
Challenging Situations *
Plumbing IssuesElectricial IssuesDrainage IssuesManagement and or Superintendent IssuesNone of the above
Is there a fan available for air ventilation? It is highly recommended to have one on hand for cleaning jobs involving hoarding, deep to heavy duty cleaning and clutter. *
During service, can the windows be opened? *
Are there any accessibility challenges? *
Important Project Requirements *Please confirm that you have read and understand that our specialty services typically require a minimum starting investment of $2,000–$3,000 and up. We also ask that you confirm you are ready to move forward with services should you decide to proceed after your consultation.
Are you within walking distance of the subway? *
Would you mind sharing photos OFFLINE of the home with us? Photos are required to help us assess the scope of the job and provide an accurate evaluation. *
Words and phrases to avoid when speaking with the customer (trigger words) *
HoardingClutterNone

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