Hometown Heating and Cooling | Belgrade, MT 59714

IAQ Evaluation

	Fill out the form below and we will contact you soon for a free in-home evaluation.

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*Name:**
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*Daytime Phone:**
Evening Phone:
*E-mail:**

Do you have pets in your home?

Yes No

Does anyone in your home smoke?

Yes No

Does anyone in your family suffer from allergies, asthma, or breathing difficulties?

Yes No

Do you ever suffer from a dry throat, dry skin or experience static electricity in your home?

Yes No

Do cooking or other odors tend to linger in your home?

Yes No

Do you use anti-bacterial household products like soap or cleaners?

Yes No

Have you ever purchased or used portable (plug-in) room air cleaners or humidifiers to relieve symptoms of unclean or dry air?

Yes No

Are there some rooms in your home that are uncomfortable or that vary dramatically in temperature? (Ex: too hot upstairs, too cool downstairs)

Yes No

Do you regularly program your thermostat for energy savings?

Yes No

10.

Has it been more than a year since you had your heating and cooling system cleaned and inspected?

Yes No