Kitchen and Bath Creations: Kitchen Design Worksheet
Full Name
First Name
Last Name
E-mail
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Home Phone
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Work Phone Ext.
How do you prefer to be contacted?
Email
Home Phone
Cell Phone
Work Phone
Planning Your Project
What type of home project are you planning?
New Construction
Remodeling
How long have you been planning your project?
0 to 3 Months
4 to 6 Months
7 to 9 Months
10 to 12 Months
Over a year
When would you like to begin this project? (Please give a date)
When would you like to have the project completed? (Please give a date)
Are you currently working with a design professional?
Yes, an architect.
Yes, an interior designer.
Yes a builder/contractor.
No.
What budget range have you established for your cabinets & countertops?
What are your plans in regards to investment in this home?
Long-term
Short-term
Is return on investment a PRIMARY concern?
Yes
No
Do you plan on renting the jobsite residence in the future?
Yes
No
Understanding Your Household
How many adults live in your household?
What are the ages of the adults in your household? (Please check all that apply)
21 to 34
35 to 50
51 to 65
65 and older
How many children reside in your household?
What are the ages of the children in your household? (Please check all that apply)
2 years and under
3 to 6 years
7 to 10 years
13 years and older
How many primary cooks are there in your household?
1
2
Shared cooking duties.
How tall is the primary cook?
5' or under
5'1" to 5'4"
5'5" to 5'9"
5'10" to 6'
6' or taller
Does anyone in your household have any physical limitations that would require special design considerations?
Yes
No
If yes please explain.
Defining Your Kitchen Usage
What type of cooking do you normally do?
Heat and serve meals.
Full course "from scratch" meals.
Bulk cooking for freezing/leftovers.
How often do your entertain guests?
Weekly
Monthly
Primarily on holidays and special ocassions.
Once or twice a year
How would you describe your hosting style (most often)?
Casual Family Style
Intimate Couples Only
Large Formal Affairs
We very rarely entertain.
How would you describe your hosting style (most often)
Casual Family Style
Intimate Couples Only
Large Holiday Gatherings
Dinner Parties (8 to 10 guests)
We rarely entertain.
Is your kitchen a socializing place?
Yes.
Yes, but I would like to change that.
No.
No, but I would like it to be.
What secondary activities will take place in your kitchen?
Computer/Home Office
Homework
Eating
Hobbies (Crafting, Sewing)
Laundry
TV/Radio
Wet Bar
Please list other activities which take place in your kitchen.
If applicable, where do you plan to sort recyclables?
Kitchen
Laundry Room
Garage
Other
How often do you shop for groceries?
Daily
Weekly
Bi-Weekly
Monthly
Defining Your Kitchen's Style
What type of feeling would you like your new kitchen space to have? Check all that apply.
Sleek & Contemporary
Warm & Cozy Country
Open & Airy
Formal
Traditional
Strictly Functional
Family Retreat
Ecclectic
Personal Design Statement
Please select the features that you would like to see in your new kitchen.
New cabinets
New countertops
New floor
New oven
New refrigerator/ freezer
New cooktop
New microwave oven
New dishwasher
New sink(s)
New light fixtures
Cutting/chopping surface
Waste disposal
Trash compactor
Recycling center
More food prep space
More storage
Pantry
Wet bar
New window(s)
Desk area
Eating area
Media/TV center
Kitchen Island
Breakfast Bar
What do you LIKE most about your present kitchen? (Please be specific)
What do you DISLIKE most about your present kitchen? (Please be specific)
Please share any other information that you believe will be helpful in creating your ideal kitchen.
Thank you for taking a moment to complete this form. Your designer will review this form with you and use it to create a kitchen that best fits your needs and life style.
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