SERVICE INTAKE FORM

CLIENT INFORMATION

CLIENT NAME

EMAIL

ADDRESS

CITY/STATE/ZIP

PHONE

PREFERRED METHOD OF CONTACT

Phone

Text

Email

HOUSEHOLD INFORMATION

NUMBER OF ADULTS

NUMBER OF CHILDREN

CHILDREN'S NAMES AND AGES

PETS (TYPE AND NUMBER)

ANY ALLERGIES OR SPECIAL HOUSEHOLD CONSIDERATIONS?

SCHEDULING PREFERENCES

PREFERRED HOURS

FLEXIBILITY

Fixed Schedule Required

Somewhat Flexible

Completely Flexible

TOP PRIORITIES FOR YOUR GIRL FRIDAY

HOUSEHOLD TASK DETAILS

WHICH 3–5 TASKS ARE MOST IMPORTANT TO YOU?

HOME ENVIRONMENT

DO YOU PREFER SOMEONE WHO IS

Very Proactive

Works from a checklist

Takes direction each visit

ARE THERE AREAS OF THE HOME THAT SHOULD NOT BE ACCESSED?

PARKING INSTRUCTIONS OR ENTRY INSTRUCTIONS

SUPPLIES & EQUIPMENT

WILL CLEANING OR HOUSEHOLD SUPPLIES BE PROVIDED BY THE CLIENT?

Yes

No

ARE THERE ANY PRODUCTS OR EQUIPMENT THE GIRL FRIDAY SHOULD NOT USE?

ADDITIONAL NOTES

ANYTHING ELSE WE SHOULD KNOW TO MATCH YOU WITH THE RIGHT GIRL FRIDAY?

SERVICE ACKNOWLEDGMENT

I understand that Girl Friday services are provided by independent contractors matched through the Girl Friday consulting service. I acknowledge that the consultant acts only as a placement service and is not responsible for work performed after placement.

CLIENT SIGNATURE

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DATE

PRINTED NAME

GIRL FRIDAY CLIENT INTAKE FORM