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HVAC
ASSESSMENT

Section 1: System Performance

How often do you experience changes in indoor temperature?

Rarely
Sometimes
Often
Always

Are there any areas in the building/home that are hotter than others?

Yes
No

On a scale of 1-5, how satisfied are you with the current heating and cooling performance?

Single choice
1
2
3
4
5

Section 2: Maintenance History

How frequently is your HVAC system professionally serviced?

Single choice
Every 6 months
Annually
Every 2 Years
Rarely
Never

Are maintenance records and reports provided by your service provider?

Single choice
Yes
No
Not applicable

Section 3: System Age and Condition

How old is your current HVAC system?

Single choice
Less than 5 years
5-10 years
More than 10 years

Have there been any major repairs required in the last two years?

Single choice
Yes
No

Section 4: Air Quality

On a scale of 1-5, how would you rate the indoor air quality in your building?

Single choice
1
2
3
4
5

Do you have concerns about odors, humidity levels, or dust?

Single choice
Yes
No

Section 5: Client Concerns and Contact Info

Please list any specific issues or concerns you have regarding your HVAC system:

Contact information for further follow-up:

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