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Welcome! I’m looking forward to working with you. Please take some time to complete the information requested below. If possible, please fill out this form in advance of our kickoff meeting so that I can review your input in preparation. Brief answers are fine.

Some tips: Involve your entire household. Have fun telling me about your wants and needs. The information gathering will help support our time together so I have a full picture of both the aesthetic and functional needs for your plan. More complete information up front leads to a better outcome. Thank you for your cooperation! All information will be kept confidential.

Note: To save and continue the form later, please scroll down to the bottom of the page and select “Save and Continue Later”

GETTING TO KNOW YOU

Date*
MM slash DD slash YYYY
Contact #1
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell
Day Phone
Evening Phone
Email*
Fax
Contact #2
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell
Day Phone
Evening Phone
Fax
Email
Is there one person who prefers to be the ‘point person” or primary contact for the day to day operations and communications?
If so, which individual:
How would you prefer to be contacted? (check all that apply)
- Home
- Work
- Cell
- Email
PART 1: HOUSEHOLD INFORMATION
House square footage:
Age of house:
Number of bedrooms:
Number of baths:
How long have you lived in your home and how long do you plan to live in your home?
Do you have plans for the future use of your residence? (Will your rooms need to serve different functions in the future for any household members?)
Household Members:
Please provide me with the names of the members of your household and what needs they have for space, work, study or special needs. Please include ages of each child.
Name
First
Example: Ben, 12
Work, Study, Space, Special Needs

Example: Will soon need own room or study space, needs better lighting in bdr. (etc)
Birthday
MM slash DD slash YYYY
Name
First
Work, Study, Space, Special Needs

Example: Will soon need own room or study space, needs better lighting in bdr. (etc)
Birthday
MM slash DD slash YYYY
Name
First
Work, Study, Space, Special Needs

Example: Will soon need own room or study space, needs better lighting in bdr. (etc)
Birthday
MM slash DD slash YYYY
Name
First
Work, Study, Space, Special Needs

Example: Will soon need own room or study space, needs better lighting in bdr. (etc)
Birthday
MM slash DD slash YYYY
Name
First
Work, Study, Space, Special Needs

Example: Will soon need own room or study space, needs better lighting in bdr. (etc)
Birthday
MM slash DD slash YYYY
Do you anticipate changes for any Household Members: (i.e. College, retirement, etc.) within the next 2-3 years? (Please explain)
Do you have pets in household? Please list type, age, special needs:
Special Considerations – Check any that apply:
- Disabled, elderly or young children in the home?
- Are occupants daytime sleepers?
PART 2: LIFESTYLE
ENTERTAINING:
Our entertaining style is:
- Formal
- Informal
- Combination of both
We entertain:
- 1-2 times/week
- 1-2 times/month
- 1-2 times/year
Average # of guests:
- 1 – 6
- 7 – 12
- More than 12
Average guests ages:
- Adults
- Teenagers
- Children
- All Ages
Entertaining Type:
- Meals
- Music
- Games
- Watching TV
Other:
MEALS:
What cooking facilities are required? Check one
- Average
- Above Average
- Elaborate
Does more than one person cook at a time?
Where do you eat your meals?
- Dining Table
- Kitchen Counter
- Kitchen Table
- Family Room
Other:
MAINTENANCE:
How many hours per week will be devoted to cleaning and/or maintenance of your home?
Do you have professionals clean your home?
If yes, how often ?
HOBBIES:
Do the household members share common time around the home together?
If yes, is an area needed to accommodate you?
Explain:
Do you have any collections?
If yes, please list:
Are any collections on display?
If you selected yes, would you like to display your collection? Where?
Hobbies
- Reading
- TV/Home Theater
- Crafts/Sewing
- Entertaining
- Music
- Sports
- Cooking
Other:
Are you looking to create a children’s play area?
If yes, please indicate where:
HOME OFFICE:
Does any household member work from home?
If yes, are there any special needs (i.e., lighting, soundproofing, computers, etc.)?
Is there a designated area for working in your home?
LIGHTING:
Is additional lighting needed?
If yes, locations:
- Bathroom
- Office
- Living Room
- Family Room
- Bedrooms
- Kitchen/Nook
Other:
STORAGE NEEDS:
Check all that apply:
- Multipurpose Furniture
- Hidden Storage (for clutter issues)
- Closet Storage/ Organizers
PART 3: PROJECT INFORMATION
Person(s) responsible for project decisions:
What is the budget for your project?
- $10,000 - $30,000
- $40,000 - $90,000
- $100,000 – $200,000
Other:
The project is to be done:
- All at one time
- In stages
Will occupants be home during project/construction for access?
If not, will you authorize neighbors or designee to provide access?
Priorities:
Please select the rooms to be included in the project:
- ENTRY HALL/FOYER
- FORMAL LIVING ROOM
- FORMAL DINING ROOM
- FAMILY/GREAT ROOM
- KITCHEN
- NOOK
- OFFICE/STUDY
- LAUNDRY AREA
- MASTER BEDROOM
- MASTER BATHROOM
- HALL/BATHROOM
- GUEST BATHROOM
- BEDROOM #2
- BEDROOM #3
- BEDROOM #4
- HOME THEATRE/MEDIA ROOM
- PLAYROOM
- OUTDOOR LIVING AREA
Other:
If the project will be done in stages, please indicate the order of the work below:
What kind of enhancements are you considering? (Please check all that apply)
- FURNITURE
- FLOORING
- REUPHOLSTERY
- REMODEL KITCHEN
- WINDOW TREATMENTS
- REMODEL BATHROOM
- WINDOW REPLACEMENTS OR CHANGES
- ARTWORK, MIRRORS, ETC
- APPLIANCES
- INTERIOR PAINT
- ACCENTS
- PLUMBING FIXTURES
- EXTERIOR PAINT
- SPACE PLANNING
- ROOM ADDITION
- WALLPAPER
- MURALS
- LIGHTING
- WALL FINISHES
- COLOR SCHEME/PAINT
Other:
What is your favorite room in the house?
Why?
What don’t you like about your current home?
Why?
What part of your house do you use the most?
What part of your house do you use the least?
Are there any pieces of furniture, window, wall or floor coverings that must stay, and be worked into the new plan? Please explain:
Are there any items that MUST GO? Please explain:
PART 4: DESIGN PREFERENCES
How involved do you wish to be in this project: (Please check)
- Very involved (Call you with details and updates daily or weekly)
- Involved – VERVE to act as project manager (Keep you updated with install dates, deliveries, work schedule etc.)
- Minimally involved – don’t call until everything is ready to install
Other:
DESIGN GOALS:
Prioritize the following personal design goals for your home from 1-3, with 1 being your most important quality.
I am interested in achieving a more stylish/beautiful appearance for my home
I want my home to function more effectively for my household.
I want my home to function more effectively for my household.
I want my home to better reflect our personal tastes.
I want my home to better reflect our personal tastes.
Would you like to include “green products” when possible?
Do you and your partner’s style preferences agree?
Comments:
The following questions are designed to provide me with a general description of your likes and dislikes regarding your personal style:
Select from any of the following to describe your preferences in fabric/pattern: (Check all that apply)
- PAISLEY
- STRIPE
- PLAID
- TOILE
- MOTIF
- GEOMETRIC
- SMALL DITZ
- CHECK
- SILK
- COTTON
- LEATHER
- BOLD PATTERN
- SUEDE
- VELVET
- LINEN
- TEXTURAL SOLID
- SUBTLE PATTERN
- SATIN
- SHEER
Other:
Preferences of Color: (Check all that apply)
- WHITES
- NEUTRALS
- BLUES
- ORANGE
- WARM COLORS
- BLACKS
- REDS
- NAVY
- RUST
- COOL COLORS
- GRAYS
- BURGUNDY
- LIGHT BLUES
- FOREST GREEN
- SUBTLE
- BEIGES/TAN
- BURNT RED
- GRAY BLUES
- SAGE GREEN
- BRIGHT
- AQUAS
- GOLDS
- MARINE BLUES
- OLIVE GREEN
- BOLD
- PINKS
- UMBER
- PALE YELLOWS
- MINT GREEN
- TONE ON TONE
- RASPBERRY
- CITRON
- PEACH
- EGGPLANT
- JEWEL TONES
- TEALS
- PASTEL
- LAVENDERS
- PURPLES
- EARTH TONES
Colors you dislike?
Do you have a color palette in mind?
If so, please describe:
Do you need sun control or privacy with your window treatments?
Additional information regarding preferences:
Have you ever hired an interior designer before?
If yes, when did this take place, and were you pleased with the experience and the results:
Thank you for your time and input. I look forward to creating a beautiful space with you!

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Beverly, MA
Ph: 860-978-4474

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