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150 Payne St Dallas,TX 75207
214-390-8300
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Carrollton: 2741 E Beltline Rd, Carrollton, TX 75006
Dallas: 6322 Gaston Avenue Dallas, TX 75214
Lifestyle Assessment Form
Your kitchen should be as unique as you are. So our first step will be to get to know you.
Lifestyle Assessment Form:
Name
*
First
Last
Email
*
Phone
*
Zipcode
*
Date
MM slash DD slash YYYY
The Basics
Household Member 1
Name
Age
Relationship
Household Member 2
Name
Age
Relationship
Household Member 3
Name
Age
Relationship
Household Member 4
Name
Age
Relationship
Household Member 5
Name
Age
Relationship
Household Member 6
Name
Age
Relationship
Who else spends significant time in your home and/or kitchen?
When was your kitchen built or last remodeled?
Any special considerations (keep kosher, mobility considerations, health concerns, etc.)?
*Note if any household members are left-handed
What spaces are adjacent to your kitchen? (Check all that apply)
Breakfast area
Family room
Dining room
Office
Laundry
Bath
Patio or deck
Other
I’d cook more if I had: (Check all that apply)
More time
More space
Better equipment and/or appliances
A more attractive environment to cook in
Company while I cooked
The ability to prepare more meals ahead of time
Other
Rate the following features in your current kitchen on a scale of 1 to 5. (1=Strongly dislike, 2=Dislike, 3=Okay, 4=Like, 5=Like a lot)
Cabinets
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Counters
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Fixtures
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Floor treatment
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Lighting
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Size of room
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Storage space
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Wall treatment
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Overall look
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Overall functionality
1 Strongly dislike
2 Dislike
3 OK
4 Like
5 Like a lot
Other
What are your hobbies and interests? (Check all that apply)
Cooking
Healthy eating
Exercise
Wine
Beer
Entertaining
Reading
Pets
Home improvement
Interior design
Art
Music
Children
Grandchildren
Other
How would you describe yourself? (Check all that apply)
A reluctant cook
A time-pressed cook
A family cook
A food enthusiast
A gourmet chef
An entertaining enthusiast
I like to eat the following. (Check all that apply)
Fresh fruits and vegetables
Vegetarian foods
Meats
Foods with dried herbs and spices
Foods with fresh herbs and spices
Baked goods
Fried foods
Coffee
Tea
Smoothies
Wine or cocktails
Soups
Rotisserie cooked foods
Indoor grilled foods
Outdoor grilled foods
Pasta
Other
I like to cook the following. (Check all that apply)
Fresh fruits and vegetables
Vegetarian foods
Meats
Foods with dried herbs and spices
Foods with fresh herbs and spices
Baked goods
Fried foods
Coffee
Tea
Smoothies
Wine or cocktails
Soups
Rotisserie cooked foods
Indoor grilled foods
Outdoor grilled foods
Pasta
Other
I do the following. (Check all that apply)
Bake a lot (e.g., pies, pastries)
Make casseroles frequently
Reheat leftovers at least 3x / wk
Fry foods weekly
Prepare sushi
Sharpen my knives at least 1x / month
I own and/or use the following. (Check all that apply)
Basting brush
Blender
Bread machine
Cast iron skillet
Colander
Cookie sheet
Cooling rack
Copper pan
Crock pot
Cutting board
Electric mixer
Food processor (e.g, Cuisinart)
Grater
Griddle
Hand mixer
Higher end SS cookware (e.g., AllClad)
Kitchen scale
Mandolin
Meat thermometer
Mixing machine
Muffin tins
Non-stick cookware
Outdoor grill
Pyrex casserole dish
Ramekins
Rice cooker
Ricer
Springform pan
Toaster oven
Toaster
Wok
Guests
What kinds of entertaining do you like/want to do in your home?
Holiday gatherings/meals for 2-8
Holiday gatherings/meals for 9-16
Holiday gatherings/meals for 16-24
Holiday gatherings/meals for 25 or more
Children’s parties
Children’s activities
Casual meals
Business entertaining
Cocktail parties
Fundraisers
Formal dining
Cookouts
Club and/or organization meetings
Other
If you were able to use your kitchen as an entertaining space, what would you like to be able to do there? (Check all that apply)
Greet friends and family
Serve drinks
Invite guests to talk and eat
Serve an entire meal
Talk with friends and family while preparing a meal
I don’t want guests in the kitchen
Other
The Future
How would you describe what you would like to do to your kitchen? (Select only one)
A facelift/touch-up
A remodel/redesign
An total do-over, including space reconfiguration and/or expansion
In what timeframe would you expect to sell your home after the kitchen remodel? (Select only one)
Less than 1 year
Within 3 years
Within 7 years
More than 7 years
What purpose does your kitchen currently serve? (Check all that apply)
A place to cook
Where my family eats
A gathering place
Where I get organized
A place to entertain
A home office
My personal space
What purpose would you like your kitchen to serve in the future? (Check all that apply)
A place to cook
Where my family eats
A gathering place
Where I get organized
A place to entertain
A home office
My personal space
Which of the following do you frequently do in your kitchen now? (Check all that apply)
Cook frequently
Read the newspaper
Watch TV
Listen to music
Respond to email
Home office work
Organize family activities
Laundry
Family meals
Informal dining
Formal dining
Entertain
Visit with family and friends
Homework and other activities with kids
Talk on the phone
Feed pets
Other
Which of the following would you like to do frequently in your remodeled kitchen? (Check all that apply)
Cook frequently
Read the newspaper
Watch TV
Listen to music
Respond to email
Home office work
Organize family activities
Laundry
Family meals
Informal dining
Formal dining
Entertain
Visit with family and friends
Homework and other activities with kids
Talk on the phone
Feed pets
Other
What features would you like to learn more about and/or consider for your remodeled kitchen? (Check all that apply)
Convection oven and/or microwave
Gas cook-top
Stainless steel appliances
Cork flooring
Organizational tools
Full extension drawers
Glass cabinets
Warming drawer
Dishwasher drawer
Refrigerator drawer
Beverage cooler
Wine storage
Wall mounted coffee system
Wet bar
Water purification system
Pot filler
Home entertainment center (TV and/or audio)
Home security center
Other
Which styles would you use to describe aspects of your home’s current interior? (Check any that apply)
Classic
Inviting
Casual
Elegant
Urban
Traditional
Contemporary
Soft Contemporary
Hip
Antique
Rustic
Up-to-date
Country
Eclectic
Sleek
Retro
Utilitarian
Natural
Artistic
Other
Which styles would you like to see in your home? (Check any that apply)
Classic
Inviting
Casual
Elegant
Urban
Traditional
Contemporary
Soft Contemporary
Hip
Antique
Rustic
Up-to-date
Country
Eclectic
Sleek
Retro
Utilitarian
Natural
Artistic
Other
If there is anything else you think we should know please tell us here.
By submitting this form, I give Kitchen Design Concepts permission to email and/or text me about my submission.
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