1. Number of Household Members:___
2. Number and approximate ages of household 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 household 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 do you eat meals?
__ Kitchen __ Dining Room
__Other:______________________
6. Where will your 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?
__A kitchen table is required
__A kitchen table is preferred but I'm 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 you 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
__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
__Bring 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? If so, please list:
__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? If so, please list:
___________________________________________
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?
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?
If Yes...
Which items do you need to sort?_____________________
8. Will you be keeping your existing applicances?
Dishwasher: __existing __new
Refrigerator: __existing __new
Oven/Range: __existing __new
Other: ___________________________
9. What is your style preference for your new kitchen?
__contemporary __formal
__country __traditional
10. Do
you have a "wish list" of items you would like to be
included in your new kitchen? If so, please list them below:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
1. Name:________________________________________________
2. Address:_____________________________________________
3. City:_________________________State:____Zip:_________
4. Home Phone:___________________________
5. Work Phone:___________________________
6. Fax:__________________________________
7. Email:__________________________________
8. New Home Address:____________________________________
9. City:_________________________State:____Zip:_________
10. Builder (if applicable):________________________
11. Phone:_______________________________
12. Fax:_________________________________
13. Architect (if applicable):_____________________
14. Phone:_______________________________
15. Fax:_________________________________
16. Interior Designer (if applicable):_____________
17. Phone:_______________________________
18. Fax:_________________________________
