| Your name: | |
| Your email address: | |
| Address: | |
| How many rooms are in your home in total? | |
| How many are bedrooms? | |
| What room would you say you spend the most time in? example Living room | |
| How many hallways/landings do you have? Hallways that span multiple floors are counted separate per floor | |
| Would any of your rooms be split rooms? example Has a large beam through the center or was it originally 1 room and split into two with different ceiling heights | |
| If yes to the above, counting each one as a whole how many rooms are like this? | |
| How many carbon-fuelled appliances do you have? For example, Boiler, Fire, heater, or flu | |
| Please list the rooms any carbon-fuelled appliance is fitted; for Example, Boiler is fitted in the Kitchen. | |
| Do you have multiple Rooms that you prepare food in Example, Second kitchen | |
| If yes to the above, how many do you have? | |
