Filterqueen Clean Home Quiz

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Clean Home Quiz

How Clean is Your Home? You and your family work hard to maintain a clean, healthy home - but is it? When it comes to pollution inside your home, there are many hidden dangers. The following questions will help you identify these dangers, recognize symptoms, and instantly assess the cleanliness of your home. Please complete the following form to receive an instant assessment of the cleanliness of your home! Thank you for participating! * indicates this field is required for form to process correctly	Name*
	Street Address*
	Address 2
	City*
	State/Province*
	Country*
	ZIP/Postal Code*
	Phone* (Please include area or country code)
	E-mail Address*

And now the questions...
(by the way, NA means this doesn't apply to your home)

Does anyone in your home smoke?	Yes No
Do you have pets?	Yes No
Do you use pesticides or moth repellents in your home?	Yes No
Do you use a humidifier or fireplace in your home?	Yes No
Does your home have an attached garage?	Yes No
Does your vacuum cleaner use a bag to collect the dirt from your home?	Yes No
Do you currently own an indoor air purifier?	Yes No
Have you had your heating/cooling ducts cleaned within the last two years?	Yes No NA
Does anyone in your home suffer from allergies or asthma?	Yes No
Do you wake up in the morning with a stuffy nose, itchy eyes or similar symptoms?	Yes No
Have you replaced or cleaned your pillows and mattress in the past six months?	Yes No
Does cleaning your home cause sneezing fits, congestion or your eyes to itch?	Yes No
Do you own a vacuum cleaner with a high-efficiency filtration system?	Yes No
Are you familiar with HEPA (High Efficiency Particulate Arrestance) filtration?	Yes No
Are you a homeowner?	Yes No
Do you change your furnace filter one or more times per year?	Yes No NA
Do you notice dust accumulating on furniture a few days after you have dusted?	Yes No
Do you vacuum your home one or more times per week?	Yes No

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