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 

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? ___________________________________________ 

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 

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

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: _________________________________