Questionnaire for Pre-Purchase/Rental EMF Assessment Please enable JavaScript in your browser to complete this form.Your name *Email address *Phone no *Property address *How did you hear about us *Internet researchBuilding Biology Institute websiteMy doctorWord of mouthOtherIf you have a coupon code, please enter belowHouse type *Single familyTownhomeApartment/CondoOwnership *To be ownedFor rentingHouse size in square feet (without basement) *Year builtFoundation Type *Finished basementUnfinished basementCrawlspaceSlabGarage type *Attached garageDetached garageNo garageNumber of bedrooms *Is there a separate office room? *YesNoNumber of floors (without basement) *Number of occupants *Number of children under 10 *Is anyone in your house diagnosed as electrically hypersensitive (EHS)? YesNoI do not know, but I feel discomfort around EMF fieldsHouse mechanicals *HVAC systemMetal ductsBaseboard heatingSplit system for heating/coolingWindow ACSolar panelElectric cookingInduction (magnetic) cookingPlease list below any concern or issues with the propertyService type *Pre-Purchase/Rental EMF Assessment with verbal report ($400)Pre-Purchase/Rental EMF Assessment with professional written report ($500)Option: EMF assessment is covered for up to 5 rooms/areas (usually the 3 bedrooms, kitchen, living/family room)E-field, M-field, and RF assessment for five rooms/areas (included)Add these assessments for 1 more room (+$50)Add these assessments for 2 more rooms (+$100)Add these assessments for 3 more rooms (+$150)Acknowledgement: You will be responsible to obtain authorization from the owner or its agent to conduct this assessment. We may turn the circuit breakers on/off a number of times during the assessment process, and we are not responsible for any damage to appliances or devices in the process, though this is not common. You may choose to keep any appliances or devices unplugged prior to starting the assessment. You or your agent must be present during the entire home visit, which may take 2-3 hours. *I acknowledge and will obtain authorizations for the aboveSubmit
