Home Safety Check Intake Form

Home Safety Check Intake

Let's make your home a safe place to explore

Thank you for booking a Home Safety Check. These questions help me understand your home, your children and what worries you most, so our walkthrough is thorough and tailored to you. Photos or a short video are hugely helpful, if you are able to share them.

Thank you

I have everything I need to prepare a thorough safety check for your home. I will be in touch soon.

About you

Your name

Phone or WhatsApp

Where are you based? town or postcode

Your children

Please list all children living in or regularly visiting the home, with their ages

Are any of them especially adventurous? climbers, fast crawlers, door openers, escape artists

Any additional needs I should keep in mind? mobility, sensory, medical

Your home

Tell me about your home house or flat, how many floors, owned or rented, any pets

Which rooms or areas would you like me to focus on?

Safety concerns

What worries you most right now? stairs, windows, the kitchen, cords, furniture tipping, fireplaces, the garden, anything at all

What have you already done to childproof the home?

Have there been any near-misses or incidents you'd like to mention?

Practical

Once we identify what's needed, will you fit items yourself or would you like a handyman to do it? I can advise either way

Is there a date or occasion you're working towards? baby becoming mobile, moving home, a new arrival

Photos of your home

Please share photos, or a short video walkthrough, of the areas that concern you

Anything else

Anything else it would help me to know?

Home Safety Check Intake Form

Let's make your home a safe place to explore

Thank you

Enjoy 10% off your first order

Here is your 10% off