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CLIENT QUESTIONAIRRE

Altadena Community Rebuilding Initiative: EquiBuild Partners New Client Intake Form

Helping Residents Navigate the Recovery and Rebuilding Process

Section 1 | Contact Information

Full Name

Phone

Preferred Contact Method

Preferred Language

If you selected "Other" for language, please specify the language you speak:

Section 2 | Property & Impact Assessment

Property Address

Property Type

If you selected "Other" for property type please specify:

Do you own or rent?

Was your property directly affected by the recent fire?

Current Condition of the Property

Approximate lot size (sq ft)

Approximate building size (sq ft)

Year Built

Was the structure permitted?

Any known environmental or zoning restrictions?

Section 3 | Rebuilding & Recover Support

What rebuilding services do you need assistance with?

What stage of the rebuilding process are you currently in?

Section 4 | Financial & Insurance Information

Have you applied for any of the following financial assistance programs?

Do you have homeowners/renter's insurance?

Section 5 | Community Resources & Support

What additional resources would be helpful to you?

Would you be interested in attending future community meetings or receiving updates about resources?

Section 6 | Final Comments

What is your biggest concern or challenge right now regarding rebuilding?

Anything else you’d like us to know?

CLIENT QUESTIONAIRRE

Altadena Community Rebuilding Initiative: EquiBuild Partners New Client Intake Form

Helping Residents Navigate the Recovery and Rebuilding Process

Section 1 | Contact Information

Full Name

Phone

Preferred Contact Method

Preferred Language

If you selected "Other" for language, please specify the language you speak:

Section 2 | Property & Impact Assessment

Property Address

Property Type

If you selected "Other" for property type please specify:

Do you own or rent?

Was your property directly affected by the recent fire?

Current Condition of the Property

Approximate lot size (sq ft)

Approximate building size (sq ft)

Year Built

Was the structure permitted?

Any known environmental or zoning restrictions?

Approximate lot size (sq ft)

Approximate building size (sq ft)

Year Built

Was the structure permitted?

Any known environmental or zoning restrictions?

Section 3 | Rebuilding & Recover Support

What rebuilding services do you need assistance with?

What stage of the rebuilding process are you currently in?

Section 4 | Financial & Insurance Information

Have you applied for any of the following financial assistance programs?

Do you have homeowners/renter's insurance?

Section 5 | Community Resources & Support

What additional resources would be helpful to you?

Would you be interested in attending future community meetings or receiving updates about resources?

Section 6 | Final Comments

What is your biggest concern or challenge right now regarding rebuilding?

Anything else you’d like us to know?

CLIENT QUESTIONAIRRE

Altadena Community Rebuilding Initiative: EquiBuild Partners New Client Intake Form

Helping Residents Navigate the Recovery and Rebuilding Process

Section 1 | Contact Information

Full Name

Phone

Preferred Contact Method

Preferred Language

If you selected "Other" for language, please specify the language you speak:

Section 2 | Property & Impact Assessment

Property Address

Property Type

If you selected "Other" for property type please specify:

Do you own or rent?

Was your property directly affected by the recent fire?

Current Condition of the Property