1. Does anyone in your home get frequent headaches, flu-like symptoms, or feel tired all the time?
   yes    no

2. Does anyone in your home have asthma, or allergies to dust, pollen or molds?
   yes    no

3. Does your furniture seem to get dusty within a few days after cleaning the house?
   yes    no

4. Is your air too dry in the winter? (static shocks, dry sinuses)
   yes    no

5. Does water drip off the inside surface of your windows in the winter?   
   yes    no

6. Do you have any uncomfortable rooms?  (too hot, too cold, stuffy or drafty)
   yes    no

7. If your home is 2 or 3 stories tall, is your top floor often too hot or too cold?
   yes    no    not applicable

8. Does your system ever run non-stop but still not keep you comfortable?   
   yes    no

9. If you have a heat pump, does it ever seem to blow cool air in the winter?  
   yes    no    not applicable

10. Does noise from your heating and cooling system bother you? (whistling, rumbling)   
   yes    no

11. How important to you is lowering your monthly utility bills? 
   very important   somewhat    not important

12. What do you NOT like about your present heating and cooling system?

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