Please take a short survey and share your thoughts with us!

We've just published a survey called 'Mold Risk Assessment', and we hope you'll take a few moments to tell us what you think.

Contact Information: Last Name: First Name: Phone Number: Address: City: State: Zip Code: Email Address: Company Name: Is Mold Affecting Your Health? Do you feel like you never quite got over your last cold or flu? Yes No Do you have allergies? Yes No Do your allergic reactions go away after you leave a building or get worse when you return? Yes No Do your allergic reactions lead to asthma-type symptoms such as difficulty breathing? Yes No Do you often have flu-like symptoms such as headaches, etc.? Yes No Do you sneeze when you enter your house or a certain room? Yes No Do you frequently have a runny nose, itchy or red eyes? Yes No Do you notice a musty smell when entering any room? Yes No Have you noticed a blackish coating on any surface at home? Yes No Have you had any water or moisture problems in your house or has your house ever been flooded? Yes No Do you have any rugs or carpets on concrete floors? Yes No Are there boxed or bagged belongings on the basement floor? Yes No Are there any stains on your ceilings? Yes No Do you have any leaky faucets, drains, or toilets? Yes No Has your sewer ever backed up? Yes No

If you answered yes to several of these questions you may have a mold problem in your home or office and you may be allergic to mold. Comments:

We respect privacy. All information collected is for internal purposes only.

Thanks, and we're looking forward to hearing your feedback.

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