Bathroom Survey Please enable JavaScript in your browser to complete this form.Name *Email *Address *Address 2 *City/Town *State *—AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP/Postal Code *Phone Number *How did you hear about us? *—Google SearchSocial Media (Facebook, Instagram, etc.)ReferralShowroomBest Picks ReportsHouzzHome AdvisorAngie's ListManufacturer/VendorLBK Work TruckHouse & Home MagTV CommercialOtherHow many people live in your household? *—12345678910How many bathrooms do you currently have? *—1234567How many master bathrooms? *—1234How many full bathrooms? *—1234567How many 1/2 bathrooms? *—1234567How long do you plan on staying in this home? *—1-5 years5-10 years10 or more yearsOtherWhat about your current bath situation prompted you to set this appointment? *Does the room need to be ADA Compliant? *—YesNoMaybeHow long have you been contemplating a bath remodel? *—1 – 5 years5 – 10 years10 or more yearsAre there any other home improvement projects that you are considering? *Current Bathroom Please select all that apply.Bath options *TubTub/Shower ComboAcrylicSteelCast IronCorner TubPlatform TubFree-StandingWalk-InWhirlpool/JacuzziWith JetsWithout JetsShower options *Shower StallAcrylicTileOtherBarrier free showerHalf wallShower-entry *Shower DoorCurtain Rod-StraightCrescentLavatory *ToiletUrinalBidetOptions *Light BarSconcesExhaust Fan/LightHeat LampLinen ClosetGrab Bar(s)Toilet Paper HolderOpen ShelvingHand-Held Shower HeadTowel Bar(s)Robe Hook(s)Medicine Cabinets *—1234Mirrors *—1234Flooring *—TileVinylOtherWalls *—PaintTileOtherAre there windows? Where are they located? *Must-Haves For New Bathroom Please select all that apply.Bath options *TubTub/Shower ComboAcrylicSteelCast IronCorner TubPlatform TubFree-StandingWalk-In Whirlpool/JacuzziWith JetsWithout JetsShower options *Shower StallAcrylicTileOtherBarrier free showerHalf wallShower entry *Shower DoorCurtain Rod-StraightCrescentLavatory *ToiletUrinalBidetOptions *Light BarSconcesExhaust Fan/LightHeat LampLinen ClosetGrab Bar(s)Toilet Paper HolderOpen ShelvingHand-Held Shower HeadTowel Bar(s)Robe Hook(s)Do you want your bathroom to be a place of relaxation? *Do you want to incorporate laundry into the space? *Do you want to expand the bathroom? *Do you want a towel warmer? *—YesNoMaybeDo you want heated floors? *—YesNoMaybeStyling Your styleFavorite colorFavorite fixture finishTub/Shower Surround/Base PreferenceCurrent Issues Please select all that apply.Problem areas *LeaksDamagesMold/MildewDifficult to cleanLimited spaceOdd layoutWater pressureTiles popping from *WallsFloorWish List All of your wish listWhat budget do you have in mind for your bathroom? *$28,000 – $40,000$40,000 – $50,000$50,000 – $60,000$60,000 – $75,000$75,000 – $100,000$100,000 – $150,000Budget not listedWhen do you plan to begin your project?When do you want to have your project completed?Submit
