Indoor Air Quality Quote Request Form Thank you for your interest in requesting an indoor air quality assessment from Synertech. Please fill out the following form to get started. Contact Information Name * First Name Last Name Email * Phone * (###) ### #### Address of Property to be Tested * Address 1 Address 2 City State/Province Zip/Postal Code Country General Property Information What type of property is this? * Residential (e.g., house, apartment) Commercial (e.g., office, retail store) Industrial Other If answered "Other", please specify. Approximate square footage of the property: * How many floors does the property have? * Approximate Age of Property or Year Built * Are there any known renovations or changes to the property’s structure or systems? * Yes No Occupancy and Usage How many people typically occupy this space? * Do you or anyone in the space have pre-existing health conditions (e.g., asthma, allergies)? * Concerns and Symptoms What concerns or issues are prompting this request? * Check all that apply Allergies or respiratory issues Odors (e.g., chemical, mold, smoke) Visible mold or mildew Excessive dust or particles Humidity issues Unexplained illnesses or discomfort Other If answered "Other", please specify. Have you noticed any specific symptoms among occupants? * Check all that apply Headaches Fatigue Eye/nose/throat irritation Difficulty breathing Other None If answered "Other", please specify. When did these concerns or symptoms first arise? Current Air Quality and Systems Do you use any of the following in your space? Check all that apply Air purifiers Dehumidifiers Ventilation systems Humidifiers Other If answered "Other", please specify. What type of heating and cooling system is installed? Check all that apply Central HVAC Radiators Space heaters Window/portable AC units Other If answered "Other", please specify. Do you regularly maintain your HVAC system (e.g., filter changes)? * Yes No Testing Priorities What are your primary concerns for indoor air quality testing? * Check all that apply Mold and mildew Allergens (e.g., dust, pet dander, pollen) Volatile organic compounds (VOCs) Carbon monoxide (CO) Radon Humidity levels Other If answered "Other", please specify. Are there specific rooms or areas of concern? * Yes No If answered YES to the previous question, please specify the rooms of concern. What outcomes or insights do you hope to gain from this testing? Additional Information Have you previously conducted any indoor air quality tests in this property? * Yes No Is there anything else you’d like us to know about your property or concerns? Thank you for your submission. A member of our team will get in touch with you shortly.
