Name
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First Name
Last Name
Email
*
Phone
*
(###)
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Property Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Do you Own or Rent?
Own
Rent
This is a Pre-Purchase Inspection
How Long Have You Lived at this Property?
Has the property ever been inspected or tested for mold?
Did the previous property owners have a water loss that you are aware of? Or, have you ever discovered evidence of water damage that occurred prior to you occupying the property?
PROBLEM #1:
* Describe the moisture/water loss event (when, where, how)
* Was the damage remediated?
* Do you have concerns that this caused a potential mold problem?
PROBLEM #2:
* Describe the moisture/water loss event (when, where, how)
* Was the damage remediated?
* Do you have concerns that this caused a potential mold problem?
PROBLEM #3:
* Describe the moisture/water loss event (when, where, how)
* Was the damage remediated?
* Do you have concerns that this caused a potential mold problem?
Are there currently any "musty" smells in certain areas of the property? If so, where?
Are there currently any "sewer gas" smells or other unknown smells anywhere in the property? If so, where?
Has there ever been a water loss inside the property that included sewage, or a floor drain backing up?
Is there a certain area of the house where occupants tend to experience more symptoms vs other areas of the property?
Do you currently have health concerns that you expect could be from mold in the property?
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Have you been previously diagnosed with CIRS or other diagnoses that may be connected to mold exposure?
Anything else you'd like to share that will help us understand your situation?
