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

  
Cooking Style

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. Who is the secondary cook? __________________________

8. Do the secondary and primary cook prepare meals
together?  __ Yes __ No

9. Is the secondary cook
__ left handed or __ right handed?

10. How tall is the secondary cook? ________

11. What are the secondary cook's responsibilities?

__ Preparing side dishes               __ Clean up
__ Assist in preparing main course

12. Does the secondary cook have any physical
limitations? ___________________________________________

  
Design and Style

1. What are your color preferences for your new kitchen?
_______________________________________________________

2. Are there colors you would not want in your new
kitchen? _______________________________________________

3. Have you created a scrapbook of notes, photos, and
ideas that you would like to use in your new kitchen?

__ Yes    __ No

4. 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

5. What do you like about your current kitchen?

_______________________________________________________
_______________________________________________________

6. What do you dislike about your current kitchen?

_______________________________________________________
_______________________________________________________

7. Do you require a recycling center in your kitchen?

__ Yes    __ No

If Yes...
How many items do you need to sort? ___

8. Will you be keeping your existing appliances?

Dishwasher:      __ existing    __ new
Refrigerator:    __ existing    __ new
Oven/Range:      __ existing    __ new

9. What is your style preference for your new kitchen?

__ contemporary    __ formal
__ country         __ traditional

  
Time and Budget

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

  
GENERAL

1. Name: _______________________________________________

2. Address: ____________________________________________

3. City: _______________________ State: ___ Zip: _______

4. Home Phone: ___________________________

5. Work Phone: ___________________________

6. Fax: __________________________________

7. New Home Address: ___________________________________

9. City: _______________________ State: ___ Zip: _______

9. Builder Name (if applicable): _______________________

10. Contact Name: ______________________________________

11. Phone: _______________________________

12. Fax: _________________________________

13. Architect Name (if applicable): ____________________

14. Contact Name: ______________________________________

15. Phone: _______________________________

16. Fax: _________________________________

17. Interior Designer Name (if applicable): ____________

18. Contact Name: ______________________________________

19. Phone: _______________________________

20. Fax: _________________________________