Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone number where your professional can reach you *State where the property needs testing - If your property is not within 50 miles of one of our service areas we DO NOT offer services in your area. (WE ALSO DO NOT RECOMMEND CONTRACTORS OUTSIDE OF OUR SERVICE AREAS) *Choose One: (REQUIRED)Arkansas - Fayettville areaArkansas - Fort Smith areaCalifornia - Los Angeles areaColorado - Denver areaFlorida - Orlando areaKentucky - Florence areaKentucky - Moscow areaKentucky - Alexandria areaOhio - Cincinnati areaOregon - Portland areaOregon - Eugene areaSouth Carolina - Greenville areaVirginia - Richmond areaVirginia - Virginia Beach areaVirginia - Charlottesville areaWashington - Seattle areaWashington - Vancouver areaStreet Address of the Property to be tested *City where the property is located *Is anyone in the property sick? *If someone in the house is sick have they been diagnosed with any of the following? *Mold Illness/Mold ExposureCIRSSick Building SyndromeAsthmaCOPD / Pulminary DiseaseMCSMCAS/ MCAD (Mast Cell)Lyme DiseaseAllergiesFood AllergiesFungal InfectionsAuto-Immune (any)FibromyalgiaChronic Fatigue SyndromeNeurological DisordersNew Onset Heart AbnormalitiesCancerThis is useful for our technicians who have learned about environmental illness and helps to give them possible clues of things to look and test for. Do you see any visible mold? *Please Choose One BelowNo, I see none at all anywhereYes, I see small areasYes, I see a large area over 3 ft in diameterYes, I see it all over the property everywhereDo you have an active water leak? *Please choose one?No, I don't see any water anywhereYes, I see water leaking somewhereWas there a previous leak in this home that you are aware of? *Yes, we had a previous leak in this homeNo we've had no leaks in this homeWe are not sure Does this property have an attic? *Please Choose OneYesNoDoes the property have a basement? *Please choose oneYesNoDoes this property have a crawl space? *Please choose oneYesNoDoes this property have forced HEAT or AIR? (HVAC?)Yes, it has forced airNo, it does not have forced airDoes this home have carpeting in "any" room? *Yes we have carpeting in this propertyNo we have no carpeting installed in this property(Answer ONLY if you said YES to carpeting) How many rooms in this property have wall to wall carpeting?1 Room2-4 Rooms5 or more roomsDoes this property have exhaust fans in every shower/bath area?Yes we have exhaust fans in every bathroom that has a shower or tub areaNo, I do not see any exhaust fans in any of the shower or tub areasDoes anyone in this property smoke cigarettes or cigars? *No one smokes in this propertyYes, someone smokes inside this propertyNot sure, someone might have smoked in this property in the last 5 years but we are new ownersDoes this property have electronics that emit Electro-Magnetic Frequencies? *No, Our home has absolutely no EMF emitting electronics. We live off the gridWe have Cable TV wifiWe have Internet wifiWe have Smart Meters installed for our utilitiesWe have cordless phones We have a microwaveWe have cellphonesWe have laptops with WIFI technologyWe have iPADSWe have Alexa or other (social communication devices)We have smart kitchen appliancesWe have smart anti theft monitoringWe have remote controls (any kind)Do any of the windows in this property leak or have condensation? *Yes, it leaks or has condensationNo we've never seen any window leaks or any condensation on any windows at this propertyWhat type of property needs to be tested? *Please choose oneApartment/CondoSingle Story Home/Ranch Style2-story home (NO basement)2-story home (WITH basement)RV or TrailerModular or Tiny HomeBarnIndustrial BuildingStrip Mall BusinessOne-Level Office Multi-Level Office complexDo you own or rent this property? *I own the propertyI rent the propertyIs this a property you are already inhabiting, a property you are interested in renting or buying or a property you are going to sell? *Please Choose OneAlready live hereInterested in Renting or Buying this propertyGoing to sell the propertyHold Old is this property? *Brand New Construction (less than one year)2-5 years old6-10 years old11-39 years oldBuilt between 1950-1980Built between 1900-1949Built in the 1800'sPlease list 2 dates you are available for testing (Starting the first day of next week) FIRST DATESECOND DATEPlease describe your concerns. - Tell us about your situation in detail so we can better help you. Tell us about anything you see, anything you might be smelling and/or any kind of physical reactions you might be having. Tell us about any past issues like floods or remediations, recent remodels, other services that might have been performed. We are here to listen!! *Where did you hear about Us? *Google SearchFacebook GroupHomeTestingPros Facebook PageLinkedInTwitterwww.SurvivingToxicMold.comA Friend referred meA Dr or Practitioner Referred MeCommentSubmit Share ThisTweetSharePlus oneShareEmailPin It