Property Appraisal Form

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Property Appraisal Form
Name*:
Name, Ages, date of birth of household members (including pets):
Address (please include Postcode)*:
Telephone/Fax*:
E-Mail*:
Best time to contact you:
Reasons for requesting a property harmonisation:
About the Property
Age & type of property:
How long have you lived there:
Do you own or rent:
Any particular reason why previous owners/occupiers left:
Please describe any significant or traumatic events in the property prior to your moving in:
Number and types of rooms:	i.e. number of bedrooms, bathrooms, reception rooms, etc.
Were several parts/buildings amalgamated to make this one property:
Do you have a garage:
Do you have a basement:
Where are the electricity meter and fuse box located:
Are any rooms located above electric meter or fuse box:
Do you have a satellite dish? If so, where is it located:
Have you had any home improvements within the last 5 years:
Possible symptoms of environmental stress in your family
Does anyone in your household suffer from::	Insomnia Lethargy Grogginess Restlessness Chronic Fatigue Nightmares Learning Difficulties Impaired Creativity Hyperactivity Glandular Fever Depression Headaches Aching Joints Allergies ME Cancer Miscarriage Accident Prone Memory Loss Relationship disharmony Business difficulties Lack of concentration Any other ailments/conditions
Please describe:
Which family member(s) suffer(s) from the above:
Man-made sources of electromagnetic stress
Any known or visible elements within 200m of the property:	e.g. power lines, railway lines, mobile masts etc.
Geopsychic activity
Please describe any paranomal activity or experiences in the property:
Verification:	Fill in the text