Consultation Questionnaire

Accessible Home
Design Questionnaire

Help us understand your home, your needs, and your vision. The more you share, the better we can design a space that works beautifully for life as it is — and as it will be.

Scroll to begin · 8 sections

Section One

Your Information

Let's start with the basics. We'll keep your details confidential.

First Name*

Last Name*

Address

City

State

Zip Code

Email*

Phone

Section Two

Project Background

A little context about your home and your plans.

1. Have you ever remodeled before?

Yes No

2. How long do you plan on living in your current home?

Less than two years 2–5 years 5–10 years 10+ years

3. How old is your home?

In the planning stages 2–5 years 5–15 years 15–25 years 25+ years

4. Predominant architectural style of your home

e.g. Craftsman, Contemporary, Federal, Georgian, Queen Anne, Saltbox, Split Level

5. My household consists of

One adult Two adults Adults and children Multiple generations under one roof

6. What do you like most about your home?

7. What do you like least about your home?

8. When it comes to cleaning and maintenance…

I enjoy cleaning my house on a regular basis I have a professional cleaning service come regularly I really dislike cleaning my house and put it off as long as possible

9. Does anyone using the home currently have physical, auditory, visual or cognitive challenges? Or are you wanting to future-proof your home?

Select all that apply

Joint or back issues Use mobility devices Hearing loss Memory loss Left-handed living in a right-handed world Chemical sensitivity Respiratory issues Visual impairment Diagnosed auto-immune disease Diagnosis of progressive/degenerative disease Future-proofing for the years ahead

10. After accessibility, which of the following would be a priority?

Safety Comfort Health and wellness Low maintenance Smart home

11. Which rooms or features of the home would you like to change?

Approach(es) / Entrance(s) Garage Kitchen Bathroom(s) Laundry Room Home Office Bedroom(s) Closet(s) Deck / Porch Backyard / Garden

Other

Section Three

Project Specifics

What features need changing — and what amenities do you desire — in each space?

12. Approaches & Entrances

Getting in and around your home

Not Applicable Smooth hard surface on walkway Stairs / Ramp Interior / Exterior Elevator Chair Lift Railing(s) Roof over entry Landing spot for packages when opening exterior door Zero-threshold entry door Wider doorway and door Ergonomic door hardware / locks Non-slip surface material(s) Lighting (illumination, decorative, safety, sensor)

Other

13. Garage

Not Applicable Door(s) Ramp(s) Handrails Lighting Storage Openers / Controls Charging station for vehicles or motorized wheelchair

Other

14. Kitchen

Not Applicable Adjustable / Multiple countertop heights Plumbing fixtures (sink height, sensor faucet, faucet location) Appliances (cooktop, refrigeration, dishwasher, auto shut-off) Cabinetry / convenience hardware (roll-out shelves, pull-out pantry) Open shelving Seated work areas Safety controls (smart outlets, dimmers, motion sensor lighting) Home automation (lighting, wi-fi appliances, door locks, blinds) Window features (operation, cleaning, coverings) Flooring

Other

15. Bathroom(s)

Not Applicable Bathing / showering — improved access & functionality Curbless shower Shower seat Hand-held showerhead Thermostatic shower valve Grab bars (shower) Bidet-style toilet Wall hung toilet Extra high toilet Grooming — dedicated seated area, lighting, countertop height Roll-up vanity Single-lever / sensor faucets Grab bars (toilet area) Storage Lighting: task, ambient, night Door / doorway Window features Safety controls (smart outlets, dimmers, motion sensor) Slip-resistant flooring Heated towel bar In-floor heating

Other

16. Laundry Room

Not Applicable

Current Location — First Floor

Current Location — Second Floor

Desired Location — First Floor

Desired Location — Second Floor

Door / doorway Raised washer / dryer Front-loading washer / dryer Easy-open storage / cabinetry Variable-height work surface Lighting Window features Access to the outdoors

Other

17. Home Office

Not Applicable Variable-height work surfaces Easy-open storage / cabinetry Lighting Office equipment & power cord access Window features Safety controls (smart outlets, dimmers, motion sensor)

Other

18. Primary Bedroom

Not Applicable

Current Location — First Floor

Current Location — Second Floor

Desired Location — First Floor

Desired Location — Second Floor

Closets / storage Transfer bars / poles Seating Dressing Doors / doorways Lighting Undercounter refrigeration for medications & toiletries Safety controls Window features Elevator / chair lift

Other

19. Other Bedroom(s)

Not Applicable

Describe bedroom(s)

Transfer bars / poles Seating Dressing Doors / doorways Lighting Safety controls Window features Elevator / chair lift

Other

20. Closets

Not Applicable

Closet Location — Room

Style

Easy-open doors that don't block access

Storage Features

Inches of hanging

Inches of double hanging

Number of drawers

Number of cubbies

Other storage features

Convenience Hardware

Closet rods Pull-down rods Pant racks Shoe racks Roll-out basket Shelves Ironing board Lighting (lighted rods, sensory lighting) Seating Laundry machines

Other

21. Deck or Patio

Not Applicable

Door threshold / Door style

Surface material(s)

Size

Railings

Roofing or sunshade Ramp Raised planter boxes Lighting Sound system Additional features

Other

22. Backyard & Garden

Not Applicable Pathway(s) Surfaces Raised planting beds Shelter Storage Lighting (area & safety) Railings

Other

23. Reduced Maintenance & Convenience

Built-in pet feeding station Built-in recycling station Hallway handrails Central vacuum (new construction only)

Section Four

Design & Style Preferences

The aesthetic vocabulary that speaks to you.

24. Do you have a particular design in mind?

Traditional Transitional Contemporary Country Craftsman Eclectic Farmhouse Coastal Mid-Century Rustic Asian Zen Industrial / Steam Punk Scandinavian

Other

25. Specific cabinet style in mind?

Undecided Painted High Presure Laminate Wood Combination of painted and wood Raised panel doors / drawers Recessed panel doors / drawers Slab panel doors / drawers

26. Specific countertop type in mind?

Not Applicable Laminate Tile Solid surface Engineered stone (e.g. quartz) Quarried stone (granite, marble) Concrete

Other

27. What type of flooring do you have in mind?

Not Applicable Linoleum Tile Wood Cork Concrete

Other

Section Five

Utility & Smart Home Preferences

The systems that keep your home running.

28. Is the lighting in your home satisfactory and comfortable?

Yes No

29. Smart Home Technology features (voice or remote activated)?

Not Applicable Security (e.g. door viewers) Interior monitoring of occupant activity Door locks Heating / cooling Lighting controls Music Security Cameras Automated window coverings Audible / visual strobe alerts (doorbell, telephone, smoke, CO₂) Charging station

Other

30. Utility Information

Heating type

Forced air Heat pump Electric baseboard Hydronic Radiator Oil furnace

Do you use gas?

Not applicable No Yes — Natural Yes — Propane

Heater Location

Gas Shutoff Location

Water Source

Private well Community well Public

Electrical Panel Location

Water Heater

Electric tank Gas tank Tank-less

Back-up Generator

None Portable Hard-wired

Sewage

Septic Public

Crawl Space Access Location

Interior Water Shutoff Location

Attic Access Location

Exterior Water Shutoff Location

31. Do you wish to change your heating or cooling system(s)?

Yes, throughout the home Yes, in specific areas of the home Replace heating/cooling controls for better accessibility & safety (e.g. voice-controlled thermostats, repositioned controls) No

32. Back-up generator and/or emergency pathway lighting in the event of a power outage?

Yes No

33. Medical equipment or supplies that need to be incorporated into the design?

Yes No

34. Phone access throughout the home, or a medical alert system incorporated into the design?

Yes No

35. Indoor air quality monitoring or controls?

e.g. automated humidity control to reduce mold, timers for ventilation systems

Yes No

Section Six

Project Fundamentals

The practical pieces — budget, timeline, and how we'll work together.

36. What is your project design and construction budget (pre-tax)?

37. How involved would you like to be in the design process?

I have certain needs/desires I want the designer to incorporate into my project I am challenged by this task and would prefer to relegate my time to choosing colors and textures

38. When it comes to design features and finishes, would you prefer to…

Have the designer opine on materials only when asked specifically Receive input on the pros and cons of each feature and finish prior to purchase

39. Target date to start your project

Design Phase

Construction Phase

40. What would you like to achieve with this consulting experience?

Learn more about Accessible Design — design for people of all abilities Learn more about environmentally friendly building products and design practices Articulate my project's goals, objectives, needs and desires to prospective builders — to minimize change orders and develop realistic estimates

41. What stood out about our company that led you to contact us?

Accessible HomeDesign Questionnaire

Your Information

Project Background

Project Specifics

Design & Style Preferences

Utility & Smart Home Preferences

Project Fundamentals

Thank you

Accessible Home
Design Questionnaire