Lumina Clean LLC
Hoarding Project Intake & Assessment Form
(336) 341-9342 | luminacleanllc@gmail.com | www.luminacleanllc.com
🔒 CONFIDENTIAL — For Office Use Only
Your information is confidential and will only be used to evaluate your project and prepare a customized proposal.
1. Client Information
2. Property Information
| Garage included? | ☐ Yes ☐ No |
Attic included? | ☐ Yes ☐ No |
| Basement included? | ☐ Yes ☐ No |
Outdoor areas included? | ☐ Yes ☐ No |
| Storage unit / additional building? | ☐ Yes ☐ No |
3. Project Overview
| How long has accumulation been present? |
☐ Under 1 yr ☐ 1–3 yrs ☐ 3–5 yrs ☐ 5–10 yrs ☐ 10+ yrs |
| Estimated severity level |
☐ Level 1 ☐ Level 2 ☐ Level 3 ☐ Level 4 ☐ Level 5 ☐ Unsure |
| How full are affected rooms? |
☐ Under 25% ☐ ~50% ☐ ~75% ☐ Floor to ceiling |
| Hallways accessible? |
☐ Yes ☐ Partially ☐ No |
| Doors fully open? |
☐ Yes ☐ No |
| Stairs safe to use? |
☐ Yes ☐ No ☐ N/A |
4. Areas to Be Included
5. Safety Concerns
Check all known or suspected safety concerns.
6. Homeowner Participation
| Will homeowner be present? | ☐ Yes ☐ No ☐ Unsure |
| Wants to participate in sorting? | ☐ Yes ☐ No ☐ Unsure |
| Set aside sentimental items? | ☐ Yes ☐ No ☐ Unsure |
| Valuables or documents present? | ☐ Yes ☐ No ☐ Unsure |
| Preferred project approach | ☐ Complete at once ☐ Stages ☐ Unsure |
7. Disposal & Organization Services Needed
Hazardous-waste coordination
Organization after cleanup
8. Scheduling Preferences
9. Additional Information
10. 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.
Return completed form to: luminacleanllc@gmail.com | (336) 341-9342 | www.luminacleanllc.com
Lumina Clean LLC — ✨ Clean home, Clear minds ✨