PSP Form - Post Green Cleaning

Full Name

Phone

1. Who resides in the home? (Check all that apply)

2. Has anyone in the home recently experienced any of the following?

Worsened allergy or asthma symptoms Respiratory discomfort (coughing, sneezing, shortness of breath) Eye, throat, or skin irritation Headaches or fatigue after recent renovations No known sensitivities

4. Have any of the following occurred recently?

5. Do you have any specific health concerns or cleaning priorities you'd like us to be aware of?

6. Would you like us to use our industrial 3-stage HEPA air scrubber during cleaning? (Removes 99.97% of airborne dust, allergens & pollutants)

Yes No Would like more information

7. Would you like a post-cleaning digital air quality analysis performed? (Recommended with air scrubber treatment)

Yes No Not sure yet

If you have any additional notes or instructions (no matter how small it may be) please feel free to mention below:

Personalized Sensitivity Profile