5Star Space Intake Form | Fivestar Space

Intake Form

Date:

Month

Day

Year

First name:

Last name:

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone:

Email:

Home Occupants, Pets:

Style of Home (# of bedrooms/bath):

1) Have you worked with a professional organizer in the past?

Yes

No

2) What prompted you to reach out to Fivestar Space?

3) Have you watched Tidying Up on Netflix or read any of Marie Kondo’s books?

Yes

No

4) Are you interested in a whole home Tidying Festival, completing all five categories: Clothing, Books, Papers, Komono, Sentimental Items?

Yes

No

5) What areas of your home are most distressing for you?

6) Describe your ideal lifestyle?

7) Write a Vision Statement for your home?

8) What is your time frame for completing your organizing project?

The following will help me gain insight into the relationships you have with things in your home. Answer the following questions per your current situation, not the ideal situation. Your answers will be used to help me

tailor each session to meet your individual needs and will be held in strict confidence.

1. I enjoy entertaining friends and family in my home.

True

Sometimes

Untrue

2. It is important to me that others like my home.

True

Sometimes

Untrue

3. My clothes and home furnishings reflect who I am.

True

Sometimes

Untrue

4. I’m not bothered when things are in disarray.

True

Sometimes

Untrue

5. I argue with family members about staying tidy.

True

Sometimes

Untrue

6. Things are in storage because there is not enough room at home.

True

Sometimes

Untrue

7. I feel guilty discarding something that was given to me as a gift.

True

Sometimes

Untrue

8. I feel sad when I discard objects from my past.

True

Sometimes

Untrue

9. I only shop when I need things.

True

Sometimes

Untrue

10. I often keep an overstock of household supplies.

True

Sometimes

Untrue

11. I consider myself a minimalist.

True

Sometimes

Untrue

12. I get frustrated because I can’t stay organized.

True

Sometimes

Untrue

13. I struggle to find things when I need them.

True

Sometimes

Untrue

14. My home supports my ideal lifestyle.

True

Sometimes

Untrue

Please rate your level of satisfaction in the following areas...

1. Financial Success

Satisfied

Neutral

Unsatisfied

2. Family Relationships

Satisfied

Neutral

Unsatisfied

3. Intimate Relationships

Satisfied

Neutral

Unsatisfied

4. Spiritual Life

Satisfied

Neutral

Unsatisfied

5. Time Management

Satisfied

Neutral

Unsatisfied

6. Health & Wellness

Satisfied

Neutral

Unsatisfied

7. Energy Level

Satisfied

Neutral

Unsatisfied

8. Peace of Mind

Satisfied

Neutral

Unsatisfied