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2. The Healthy Homes Program takes a comprehensive approach by focusing on housing-related hazards in a coordinated fashion, rather than addressing a single hazard at a time including mold, water intrusion, lead paint, allergens, asthma, carbon monoxide, home safety, pesticides, and radon (a dangerous gas found mainly in basements). Fill out this interest form and we will be in touch!

4. Name*
5. Preferred Method of Contact:
   -- Select One --E-mailPostal MailPhone
7. Address*
9. City*
10. State*
11. Zip*
13. Phone Number*
14. E-mail Address
16. Do you rent or own your home?*

    1. Rent
    2. Own
18. What year was the home built? *

    1. Pre-1900
    2. 1901 - 1920
    3. 1921 - 1940
    4. 1941 - 1960
    5. 1961 - 1980
    6. 1981 - 2000
    7. 2001 - Present
    8. Unknown
20. Do children under the age of 6 live in the home or regularly visit?*

    1. Yes
    2. No
22. Which of the following do you feel applies to your home? Check all that apply.*

    1. Mold/moisture problems
    2. Plumbing issues
    3. Electrical hazards
    4. Tripping/slipping hazards
    5. Uneven/broken stairs
    6. Low lighting in the home
    7. Security concerns
    8. Lead paint hazards
    9. Excess heat or cold in the home
    10. Deterioration and/or falling debris
24. Please list any other concerns you have regarding the health and safety of your home.
26. Do you or someone in your household experience any medical concerns that our inspection staff should be aware of? If so, please explain.
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field