1. Biographical Context & Sensitivity Profile
What is your current age and biological sex?
Select biological sex
Male
Female
Other
Prefer not to say
Age affects circadian sensitivity, hormonal vulnerability to EMF, and recovery requirements.
Have you been diagnosed with or suspect any of the following conditions?
These conditions indicate heightened environmental sensitivity requiring modified exposure thresholds.
How many years have you lived in your current residence?
Select duration
Less than 6 months
6-12 months
1-2 years
2-3 years
3-5 years
5-10 years
10+ years
Cumulative exposure duration affects total body burden from VOCs, EMF, and material off-gassing.
When was your building constructed or last majorly renovated?
Select era
Before 1900
1900-1940
1940-1978 (lead paint era)
1978-2000
2000-2010
After 2010
Unknown
Construction era determines material composition, VOC off-gassing stage, wiring standards, and insulation type.
Have you experienced symptom improvement when away from this environment for 5+ days?
Symptom cycling with environment presence/absence is a key indicator of environmental exposure burden.
2. Sleep Environment & Recovery
If you track sleep, what is your average sleep efficiency?
Select range (or skip if not tracked)
Don't track sleep
Less than 70%
70-79%
80-84%
85-90% (healthy baseline)
90-95% (excellent)
Above 95%
Sleep efficiency = (total sleep time / time in bed) × 100. Healthy baseline is 85-95%.
How long does it typically take you to fall asleep?
Select time
Less than 10 minutes
10-20 minutes
20-30 minutes
30-60 minutes
More than 60 minutes
Highly variable
How many times do you typically wake during the night?
Select frequency
Never or once
1-2 times
3-4 times
5 or more times
Highly variable
How do you feel when you wake up in the morning?
Select description
Refreshed and energized
Decent after 10-15 minutes
Groggy for 30+ minutes
Exhausted, as if didn't sleep
Headache or brain fog
Morning symptoms correlate with overnight CO₂ accumulation and VOC concentration patterns.
What material is your mattress?
Select material
Memory foam
Innerspring
Natural latex
Synthetic latex
Hybrid
Other
Don't know
How old is your mattress?
Select age
Less than 1 year
1-2 years
2-3 years
3-5 years
5-8 years
8+ years
Memory foam and synthetic materials off-gas VOCs intensely in first 6-24 months, continuing for years.
Do you notice any smells in your bedroom?
Olfactory detection indicates VOC presence. "No smell" doesn't guarantee safety—many VOCs are odorless.
Where is your phone while you sleep?
Select location
On nightstand (within 3 feet)
Across the room (6+ feet)
Outside bedroom
Don't have phone in sleeping area
EMF exposure follows inverse square law—doubling distance reduces exposure by 75%.
What mode is your phone in overnight?
Select mode
Airplane mode
Powered off
WiFi off, cellular on
Fully active (WiFi + cellular)
N/A - phone not in bedroom
How dark is your bedroom while sleeping?
Select darkness level
Completely dark (can't see hand)
Mostly dark (slight ambient glow)
Moderate (can see objects)
Quite bright (streetlights, screens)
Do you have blackout curtains or shades?
Select option
Yes, complete blackout
Yes, partial blackout
Regular curtains/blinds
No window coverings
No windows in bedroom
How noisy is your bedroom at night?
Select noise level
Very quiet - no disturbances
Quiet - minimal noise
Moderate - some noticeable noise
Loud - frequent disturbances
Very loud - constant noise
What are your main noise sources at night?
What temperature do you keep your bedroom at night?
Select temperature range
Under 65°F
65-68°F (optimal for sleep)
68-72°F
72-75°F
Over 75°F
No temperature control
Don't know
Optimal sleep temperature is 65-68°F. Temperature instability disrupts sleep stages.
3. Air Quality & Respiratory Environment
How would you describe your home's overall air quality?
Select description
Excellent - always fresh and clean
Good - generally comfortable
Fair - occasionally stuffy or stale
Poor - often feels stuffy or unpleasant
Very poor - consistently uncomfortable
Do you experience respiratory or sinus symptoms at home?
What type of HVAC system do you have?
Select system type
Central forced air (ducted)
Radiator or steam heat
Mini-split / ductless
Window AC units
Baseboard electric
No HVAC system
Don't know
How often do you change your HVAC filter?
Select frequency
Monthly
Every 2-3 months
Every 6 months
Annually
Rarely or never
N/A - no HVAC or don't change
Don't know
What type of filter do you use?
Select filter type
Basic fiberglass (cheap filters)
Pleated MERV 8-11
High-efficiency MERV 13-16
HEPA filter
Don't know
N/A - no filter
How often do you open windows for fresh air?
Select frequency
Multiple times daily
Daily
Few times per week
About weekly
Rarely
Never
Have you ever had water damage, flooding, or visible mold?
Select status
Yes - currently present
Yes - past issue, professionally remediated
Yes - past issue, DIY cleanup
Yes - past issue, not remediated
No water damage or mold
Not sure
Mold exposure creates mycotoxin burden affecting 25% of population significantly.
Do you use any combustion sources indoors?
Gas stoves can elevate indoor NO₂ to levels exceeding outdoor air quality standards.
What type of cleaning products do you primarily use?
Select primary type
Conventional (Lysol, Clorox, Windex, etc.)
Natural/eco-friendly (Method, Seventh Generation, etc.)
DIY (vinegar, baking soda, etc.)
Mix of conventional and natural
What is your home's humidity level?
Select humidity range
Very dry (under 30%) - static, dry skin
Somewhat dry (30-40%)
Comfortable (40-60%)
Somewhat humid (60-70%)
Very humid (over 70%) - condensation, dampness
Don't know
Optimal indoor humidity is 40-60%. Below 30% causes respiratory irritation; above 60% promotes mold growth.
4. Water Quality & Hydration
What is your water source?
Select source
Municipal/city water
Private well
Don't know
Do you filter your drinking water?
Select filtration type
Whole-house filtration system
Under-sink filter
Countertop filter
Pitcher filter (Brita, PUR, etc.)
Reverse osmosis system
Refrigerator filter
Multiple systems
No filtration
Have you noticed any water quality issues?
When was your building's plumbing last updated?
Select timeframe
Within last 5 years
5-10 years ago
10-20 years ago
20+ years ago
Never updated (original plumbing)
Don't know
Pre-1986 plumbing may contain lead solder. Pre-1930 buildings may have lead service lines.
Do you filter your shower water?
Select option
Yes - have shower filter
No shower filter
Whole-house filter covers shower
How long and hot are your typical showers?
Select typical shower
Short (<5 min), cool/warm water
Short (<5 min), hot water
Medium (5-10 min), warm water
Medium (5-10 min), hot water
Long (10-20 min), warm water
Long (10-20 min), very hot water
Very long (20+ min), hot water
Chlorine and VOCs vaporize in hot showers, creating inhalation exposure. 10-minute hot shower = drinking 8 glasses of unfiltered water.
5. Light Environment & Circadian Health
Do you get bright light exposure within 60 minutes of waking?
Select option
Yes - outdoor sunlight daily
Yes - through window/indoor bright light
Sometimes
Rarely
Never / wake in darkness
Morning bright light within 30-60 min of waking anchors circadian rhythm.
How would you rate natural light in your home during the day?
Select description
Excellent - abundant natural light
Good - decent natural light in most rooms
Fair - some natural light but often need artificial
Poor - minimal natural light
Very poor - basement or interior rooms
What type of artificial lighting do you primarily use?
Select primary type
LED bulbs
CFL (compact fluorescent)
Incandescent/halogen
Mix of types
Don't know
What color temperature are your main lights?
Select color temperature
Warm (2700K-3000K, yellowish)
Neutral (3500K-4100K, white)
Cool/daylight (5000K+, bluish)
Mix of temperatures
Don't know
Do you dim lights in the evening (after 7-8 PM)?
Select practice
Yes - consistently dim 2-3 hours before bed
Yes - sometimes
Yes - in some rooms only
No - don't have dimmers
No - lights stay bright until bedtime
Melatonin production requires dim light (<10 lux) starting 2-3 hours before bed.
How much screen time do you have in the 2 hours before bed?
Select amount
No screens before bed
Less than 30 minutes
30-60 minutes
1-2 hours
2+ hours constantly
Do you use blue light blocking tools?
Select what you use
Blue light blocking glasses
Screen filters/night mode apps
Both glasses and filters
None
Do you experience seasonal mood or energy changes?
Select description
Yes, significant (diagnosed SAD or strong pattern)
Yes, moderate (noticeable but manageable)
Subtle changes only
No seasonal pattern
6. Electromagnetic Environment
Where is your WiFi router located?
Select location
In bedroom or adjacent wall
Same floor, within 15 feet of bedroom
Living area, distant from bedroom
Basement or different floor
No WiFi router (use ethernet)
Do you turn off WiFi at night?
Select practice
Yes - always turn off at night
Sometimes
No - always on 24/7
N/A - no WiFi
How many WiFi networks can you detect from your bedroom?
Select count
0-2 networks
3-5 networks
6-10 networks
10-20 networks
20+ networks (dense apartment/condo)
In apartments, cumulative RF from neighboring networks creates 24/7 exposure even if your router is off.
Do you have a smart meter on your building?
Select option
Yes - on exterior wall of bedroom
Yes - on other exterior wall
No smart meter
Don't know
Do you have any high-EMF sources nearby?
Have you experienced symptoms you associate with device use?
7. Materials & Chemical Exposure
What type of flooring is in your bedroom?
Select flooring type
Solid hardwood
Engineered hardwood
Carpet (synthetic)
Carpet (natural fiber - wool)
Tile (ceramic/porcelain)
Vinyl/laminate
Concrete or polished cement
Other
When was your bedroom flooring installed?
Select age
Within the last year
1-3 years ago
3-5 years ago
5+ years ago
Original to building
Don't know
Laminate and vinyl flooring off-gas VOCs. New finishes emit for 6-12 months.
Have you purchased new furniture in the past 2 years?
Select option
Yes - multiple pieces
Yes - 1-2 pieces
No new furniture
When were your walls last painted?
Select timeframe
Within the last year
1-2 years ago
2-3 years ago
3-5 years ago
5+ years ago
Don't know
What type of paint was used?
Select paint type
Zero-VOC paint
Low-VOC paint
Conventional paint
Don't know
Haven't painted in 5+ years
Standard paint off-gasses VOCs for 6-24 months. Low-VOC/zero-VOC reduces exposure significantly.
Do you have any of these high-exposure items?
What type of personal care products do you use before bed?
Select primary type
Conventional (drugstore brands)
Natural/organic/"clean beauty"
Minimal products
None before bed
What laundry products do you use?
Select type
Conventional detergent + fabric softener/dryer sheets (scented)
Conventional detergent only (unscented)
Natural/eco-friendly brands
DIY (soap nuts, homemade, etc.)
8. Health Patterns & Symptoms
How would you rate your overall sleep quality?
Select rating
Excellent - wake refreshed, feel great
Good - generally sleep well
Fair - some issues but manageable
Poor - frequent issues, not refreshing
Very poor - chronic sleep problems
How many hours do you typically sleep per night?
Select hours
Less than 5 hours
5-6 hours
6-7 hours
7-8 hours
8-9 hours
9+ hours
Do you experience any of these health issues regularly?
Rate your energy level at different times of day (1-10):
Upon waking:
Select
1-2 (Exhausted)
3-4 (Low)
5-6 (Moderate)
7-8 (Good)
9-10 (Excellent)
Mid-morning (10 AM):
Select
1-2 (Exhausted)
3-4 (Low)
5-6 (Moderate)
7-8 (Good)
9-10 (Excellent)
After lunch (2 PM):
Select
1-2 (Crash)
3-4 (Low)
5-6 (Moderate)
7-8 (Good)
9-10 (Excellent)
Evening (7 PM):
Select
1-2 (Exhausted)
3-4 (Low)
5-6 (Moderate)
7-8 (Good)
9-10 (Excellent/Wired)
Energy patterns reveal circadian rhythm health and environmental impact.
9. Lifestyle & Movement Patterns
How many hours per day do you spend sitting?
Select hours
Less than 4 hours
4-6 hours
6-8 hours
8-10 hours
10-12 hours
12+ hours
Sedentary time affects circulation, lymphatic drainage, and toxin processing.
How often do you exercise or move intentionally?
Select frequency
Daily
5-6 times per week
3-4 times per week
1-2 times per week
Occasionally
Rarely or never
How much time do you spend outdoors in nature per week?
Select amount
Less than 1 hour
1-2 hours
2-5 hours
5-10 hours
10+ hours
Nature exposure reduces cortisol and improves parasympathetic tone. Less than 2 hours weekly is deficient.
What is your typical eating window (first to last meal)?
Select duration
Less than 8 hours (time-restricted)
8-10 hours
10-12 hours
12-14 hours
14-16 hours
16+ hours (eating all day)
Highly variable
How would you rate your stress level?
Select level (1-10)
1-2 (Very low stress)
3-4 (Low stress)
5-6 (Moderate stress)
7-8 (High stress)
9-10 (Extreme stress)
Do you practice any stress regulation techniques?
10. Goals & Priorities
What prompted you to seek environmental intelligence services?
What are your top 3 priorities? (Select 3 and we'll discuss priority order in consultation)
What would environmental optimization success look like for you? (2-4 sentences)
What is your approximate budget for implementing environmental improvements?
Select budget range
Exploring (under $2,000)
Moderate ($2,000-$5,000)
Significant ($5,000-$10,000)
Comprehensive ($10,000-$25,000)
Extensive ($25,000+)
Flexible based on ROI
What is your preferred implementation timeline?
Select timeline
Immediate (within 2 weeks)
Near-term (1-2 months)
Medium-term (3-6 months)
Long-term (6-12 months)
Phased over time based on priorities