Confidential Hoarding Assessment Form

🔒 Your information is confidential and will only be used to evaluate your project and prepare a customized proposal. All submissions are reviewed by Lumina Clean LLC staff only. We treat every inquiry with complete discretion and respect.

1. Client Information

Today's Date * Client Full Name *

Relationship to Homeowner *

Phone Number * Email Address *

Preferred Contact Method * Phone Text Email

2. Property Information

Property Address *

City * State * ZIP Code *

Approx. Square Footage Bedrooms Bathrooms Stories

Garage included Attic included Basement included Outdoor areas included Storage unit or additional building

3. Project Overview

How long has the accumulation been present? Estimated severity level Approximately how full are the affected rooms?

Are hallways accessible? Can doors fully open? Can stairs be used safely?

6. Homeowner Participation

Will the homeowner be present? Does the homeowner want to participate in sorting? Should sentimental items be set aside? Are valuables or important documents believed to be present?

Preferred project approach

8. Photos & Videos

Please include clear photos or a short video of affected rooms, hallways, entrances, stairs, the garage, and storage areas.
Do not upload identification documents, financial records, or unrelated private information.

Upload Photos / Videos Accepted formats: JPG, JPEG, PNG, HEIC, PDF, MP4, MOV | Max 25 MB per file | Max 100 MB total | Files are stored securely and not accessible publicly.

9. Scheduling Preferences

Preferred consultation date Preferred consultation time Preferred project start date Completion deadline (if any)

Is travel required for this project? Best days and times to contact you

10. Additional Information

Please tell us anything else that would help us understand the project.

11. Acknowledgments & Signature

I certify that the information submitted is accurate to the best of my knowledge. * I understand this form is a request for an assessment and is not a final quote. * I understand Lumina Clean LLC may decline work involving hazards outside its licensing, insurance, training, or safety capabilities. * I consent to being contacted by phone, text, or email regarding this request. *

Typed Full Name (Electronic Signature) * Date *

By typing your name above, you acknowledge that this constitutes your electronic signature and agreement to the acknowledgments listed above.

Privacy Notice: The information submitted in this form will be used solely to evaluate your hoarding cleanup project and prepare a customized proposal. Your information will not be sold, shared with third parties for marketing purposes, or disclosed except as required by law. Files you upload are stored securely with randomized filenames and are not publicly accessible.

Fields marked with * are required.

📋 Confidential Hoarding Project Assessment