Questionnaire

What water quality issues are you currently concerned about? Please select as many as are relevant.

Do you currently have any water purification/treatment systems installed in the home?:

Yes

No

If yes, please describe:

How is water supplied to your home?:

Municipal supply

Private well

Shared community well.

Total number of bathrooms in your home?:

Total number of residents?:

Do you currently have a sprinkler system installed in your home, or any other water using devices that you would like to be bypassed?:

Yes

No

Not Sure

If yes, please describe:

If you have had any recent water quality tests performed, please share them here: Hardness (expressed as grains per gallon), Total Dissolved Solids (parts per million), Iron (parts per million), Other water quality parameters.:

If you would like to upload any pictures/files of your current water treatment system or household plumbing, please attach them here::

Preferred method and time of contact:

Thank you for completing our questionnaire. A water specialist will review your information and contact you as soon as possible. We look forward to improving the quality of your water!

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