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 __smal 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 

1. Who is the primary cook?_____________________________ 

2. Is the primary cook __lef 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?___________________________________________ 

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 applicances? 

Dishwasher:	__existing	__new
Refrigerator:	__existing	__new
Oven/Range:	__existing	__new 

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

__contemporary	__formal
__country		__traditional 

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: $________________ 

1. Name:________________________________________________ 

2. Address:_____________________________________________

3. City:_________________________State:____Zip:_________

4. Home Phone:___________________________ 

5. Work Phone:___________________________ 

6. Fax:__________________________________ 

7. New Home Address:____________________________________ 

8. 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:_________________________________