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CLIENT QUESTIONNAIRE

ROOM DETAILS

Vaulted or Recessed Ceiling
No
Yes, Recessed
Yes, Vaulted

ADDITIONAL INFORMATION

Do either/both resident(s) have physical limitations?
Yes
No
Preferred Style

YOUR SURROUNDINGS

What surroundings colors/shades give you the greatest peace?

Choose your top three favorite colors/shades by name & number:

YOUR LIFE

Is your life in general.....

UPLOADS

Date
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