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Clear Space Solutions: Client Intake Form

Welcome to Clear Space my!

We’re excited to help you create a cleaner, more organized, and stress-free space.

Please take 3–5 minutes to complete this form so we can:

Choose your recurring or one-time service
Learn about your space for an accurate quote
Understand your scheduling and payment preferences

After you submit the form, we’ll review your details and reach out to confirm your service.

Thank you for trusting us to help you create a clearer, calmer space!

SECTION 1: PERSONAL INFORMATION

First name

Last name

Phone

Preferred form of contact

Text Message

Both

Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

How did you hear about us? (Referral, Instagram, Website, Other)

Referral

Social Media Ad

Website

Other

Referred by..

SECTION 2: HOME INFORMATION

# of Bedrooms

Studio/1 Bedroom

2 Bedrooms

3 Bedrooms

4+ Bedrooms

Pets In the home?

Yes

Pet Information

Please specify what type and number of pets

Square Footage (optional)

SECTION 3: SERVICE SELECTION

Type Of Service

Refresh Clean (one-time)

Reset Deep Clean (one-time)

Move In/ Move Out Clean

First Time Client Deal ($89 + 1 $10 add-on)

Special Care Services ( ie. emergency, unique situations, event clean up)

Interested in Add-Ons?

Home Condition/Additional Notes

Any information we need to know about your home, like any special areas, or requests.

SECTION 4: SCHEDULING PREFERENCES

1st Preferred Service Date & Time

Month

Day

Year

Time

HoursMinutes

2nd Preferred Service Date & Time

Month

Day

Year

Time

HoursMinutes

Are you flexible if these slots unavailable?

yes

Other Availability notes

Lets us know if you prefer mornings or afternoons, or have any other dates in mind.

SECTION 5: PAYMENT METHOD PREFERENCE

*All information is kept confidential and used solely for

Clear Space Solutions services.