1. Number of family members: ___
2. Number and approximate ages of family members:
__ infants __ young children __ teens
__ 20 to 30 yrs __ 31 to 40 yrs __ 41 to 50 yrs
__ 51 to 60 yrs __ 61 to 70 yrs __ 70+
3. If your family has young children, will they be using
the kitchen frequently?
__ Yes __ No
4. How long do you plan on living in the home you are
remodeling/building?
__ 1 to 5 yrs __ 6 to 10 yrs __ 11 to 20 yrs __20+
5. Where does your family eat its meals?
__ Kitchen __ Dining Room
__ Other:______________________
6. Where will your family eat after you remodel/build?
__ Kitchen __ Dining Room
__ Other:_____________________
7. Do you require a kitchen table or would you be willing
to explore other options if a design could be improved?
__ A kitchen table is required
__ A kitchen table is preferred but open to other options
__ A kitchen table is not necessary
8. What other activities will take place in your new
kitchen?
__ Laundry __ Homework __ Watching TV
__ Paying Bills __ Sewing __ Computer Center
__ Other:___________________ __ Other:_____________
9. After your remodel/build will you entertain
frequently?
__ Yes __ No
If Yes...
What is your entertainment style? __ formal __ informal
Do you have __ large or __ small gatherings? _Do your guests help you in the kitchen when
you entertain?
_ Yes __ No
10. How do you shop? __ For the week __ Buy in bulk and freeze __ For each meal __ Buy non-perishable items in bulk If you buy in bulk, do you require storage in the kitchen for all or most of these items? __ Yes __ No
1. Who is the primary cook?
____________________________
2. Is the primary cook __ left handed or __ right handed?
3. How tall is the primary cook? _______
4. What is the primary cook's cooking style?
__ Gourmet Meals __ Family Meals
__ Quick & Simple Meals
__ Bringing Meals Home __ Baking
5. What does the primary cook prefer?
__ No one else in the kitchen while preparing meals.
__ A helper in the kitchen when preparing meals.
__ Family or friends visiting during meal preparation.
6. Does the primary cook have any physical limitations?
__ Yes __ No
7. Is there a secondary cook?
__________________________
8. Do the secondary and primary cook prepare meals
together?
__ Yes __ No
9. How tall is the secondary cook? ________
10. What are the secondary cook's responsibilities?
__ Preparing side dishes __ Clean up
__ Assist in preparing main course
11. Does the secondary cook have any physical
limitations?
___________________________________________
1. What are your color preferences for your new kitchen?
__________________________________________
2. Are there colors you would not want in your new kitchen? __________________________________________
3. What is your style preference for your new kitchen?
__ contemporary __ formal__ country __ traditional
4. Is this kitchen a remodeling project or a part of a new construction project?
__ Yes __ No
5. Have you created a scrapbook of notes, photos, and
ideas that you would like to use in your new kitchen?
__ Yes __ No
6. If a design could be greatly improved, would you be
willing to make structural changes? (i.e. moving windows,
doors, and walls)?
__ Absolutely not __ I would consider it
7. What do you like about your current kitchen?
___________________________________________
___________________________________________
8. What do you dislike about your current kitchen?
_______________________________________
_______________________________________
9. Do you require a recycling center in your kitchen?
__ Yes __ No
If Yes... How many items do you need to sort? ___
9. Will you be keeping your existing appliances?
Dishwasher: __ existing __ new
Refrigerator: __ existing __ new
Oven/Range: __ existing __ new
1. When would you like to begin your project?
______
_____________________________________________
2. When would you like your project completed?
______
_____________________________________________
3. If you are building, is the kitchen in your contract?
__ Yes __ No
4. Do you have a budget for this project?
__ Yes: $ ________________ __ No
1. Name:
_____________________________
2. Address
_____________________________
3. City: ______________State:_________________Zip:_____
4. Home Phone:
_____________________________
5. Work Phone:
_____________________________
6. Fax:
_____________________________
7. New Home Address:
_____________________________
8. City: ______________State:_________________Zip:_____
9. Builder Name (if applicable):
_____________________________
10. Contact Name:
_____________________________
11. Phone:
_____________________________
12. Fax:
_____________________________
13. Architect Name (if applicable):
_____________________________
14. Contact Name: (if applicable):
_____________________________
15. Phone:
_____________________________
16. Fax:
_____________________________
17. Interior Designer Name (if applicable)
_____________________________
18. Contact Name: (if applicable):
_____________________________
19. Phone:
_____________________________
20. Fax:
_____________________________