Step 1 of 2

Once you click Submit on this form, you'll be taken to Step 2 where you can schedule your phone call.

If you do not complete Step 2 and schedule a phone call, then you will not get your consult call.

"*" indicates required fields

First, tell us about yourself

Name*

First Last

Country*

Email*

Phone*

Phone Number Consent

I consent to receiving SMS alerts and reminders at the phone number I provided.

*We do not sell your information.

Street Address*

City*

State / Province*

Zip / Postal Code*

How did you hear about us?*

How Were You Referred to Us?*

Hidden

site

If Other*

Doctor name*

Health Coach name*

Which Podcast did you hear about us on?*

Which conference or webinar did you hear about us at?*

Next, tell us about your situation

Why do you believe your health is being impacted by mold?*

Do you have any clinical testing, or has your doctor confirmed that mold is impacting your health?*

If yes, please tell us more*

Why are you looking to address your mold issue now?*

What have been your biggest struggles in addressing your mold issue?*

What have you tried so far to address your mold issue? Including self tests, inspections, remediation, etc.*

What are you wanting to achieve by working with us?*

Are you currently in the process of looking for a new home?*

Almost done, tell us about your home

Do you own or rent your home?*

What type of home do you live in?*

Please Specify*

What size is your home?*

When was your home (or building) built?*

How long have you lived there?*

Do you have an attic?*

Is there access to the attic?*

Do you have a basement?*

Basement Type*

Do you have a crawl space?*

Is there access to the crawl space?*

Do you have central heating or air conditioning?*

How many central heating/cooling systems do you have?*

Approximate age (years) of your heating/cooling system?*

Where is your central heating/cooling system(s) located?

Are you aware of any previous leaks or water events in your home? If so, please describe.*

Last thing, a few final details to schedule your phone call...

Do you have a spouse, partner, or family member that will be part of the decision making process?*

Do you have their support to address your mold situation?*

Do you need their approval to make a decision?*

Are you able to make a financial commitment without their approval?*

All parties involved in the decision making process must be present for our call. If they are not present, the call will need to be cancelled and rescheduled. Please confirm you understand by selecting "Yes".*

Yes

Where would you say you are on a scale of 1-10, 10 being ready to take action as long as it's simple and effective?*

Are you open to online consulting as a method to address your mold issue?*

What do you feel is a realistic budget range you can allocate to address your mold situation?*

This will help us provide better solutions for you.

On the day of the call, If you feel we are a good fit, are you able to submit an initial deposit to reserve an inspection date?*

We are often booked 2-3 weeks in advance. Placing a deposit for an inspection will help you secure an inspection so you can receive the help you seek as soon as possible.

Step 1 of 2

Once you click Submit on this form, you'll be taken to Step 2 where you can schedule your phone call.

If you do not complete Step 2 and schedule a phone call, then you will not get your consult call.

First, tell us about yourself

Next, tell us about your situation

Almost done, tell us about your home

Last thing, a few final details to schedule your phone call...

Clicking Submit DOES NOT Confirm Your Phone Call.
You must schedule a time on the next page.

Application Form

Need an ERMI? First, tell us a little about yourself...

Step 1 of 2

Once you click Submit on this form, you'll be taken to Step 2 where you can schedule your phone call.

If you do not complete Step 2 and schedule a phone call, then you will not get your consult call.

First, tell us about yourself

Next, tell us about your situation

Almost done, tell us about your home

Last thing, a few final details to schedule your phone call...

**Clicking Submit DOES NOT Confirm Your Phone Call. You must schedule a time on the next page.**

Application Form

Need an ERMI? First, tell us a little about yourself...

Clicking Submit DOES NOT Confirm Your Phone Call.
You must schedule a time on the next page.