Lifestyle Assessment Form

Lifestyle Assessment Form:

Name*

First Last

Email*

Phone*

Zipcode*

Date

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

Counters

Fixtures

Floor treatment

Lighting

Size of room

Storage space

Wall treatment

Overall look

Overall functionality

Other

What are your hobbies and interests? (Check all that apply)

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)

I like to cook the following. (Check all that apply)

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)

Guests

What kinds of entertaining do you like/want to do in your home?

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)

Which of the following would you like to do frequently in your remodeled kitchen? (Check all that apply)

What features would you like to learn more about and/or consider for your remodeled kitchen? (Check all that apply)

Which styles would you use to describe aspects of your home’s current interior? (Check any that apply)

Which styles would you like to see in your home? (Check any that apply)

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.

Your kitchen should be as unique as you are. So our first step will be to get to know you.

The Basics

Guests

The Future

SHOWROOM

150 Payne St
Dallas, TX 75207
Phone 214.390.8300

Sign Up for Our Newsletter

Lifestyle Assessment Form

Your kitchen should be as unique as you are. So our first step will be to get to know you.

The Basics

Guests

The Future

SHOWROOM

150 Payne St Dallas, TX 75207 Phone 214.390.8300

Sign Up for Our Newsletter

Subscribe

150 Payne St
Dallas, TX 75207
Phone 214.390.8300