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Your Name
E-Mail Address
Phone Number
Street
Suburb/City State Postcode
Age 18-2930-4950-6970+
Budget $200k-$299k$300k -$399k$400k-$499k$500k-$599k$600k-$699k$700k-$799k>$800k
Style of Home Unit villa (eg 2-5 units on the one block) House and Land package: (land, house and fully landscaped) House only: Build a house / unit on your land Demolish existing home and build a new home Part of a special purpose apartment complex
Number of bedrooms 1234>4
Number of bathrooms 12>2
Size Block Small (less than 500m2)Medium (500m2 to less than 800m2)Large (800m2 or more)
When are you wanting to buy or build? As soon as possibleWithin the next 12 months1-2 Years3-5 Years5+ Years
Specialised storage requirments gardening equipment (lawn mower etc) collections (eg wine, craft) large book cases specific furniture (eg antique sideboard) display cabinets filing cabinets tools piano space to keep campervan / boat / trailer other
Specific hobbies woodwork vegie gardening library spare room (eg craft, art studio, music, gym, office) other
Guest room fold down bed yes no
Pet Requirements area to wash/groom dog chicken coop other
Does anyone in your home have any access requirements? yes no
What Lifetime Homes features would you like to incorporate?
Spacious doorways, hallways and garages yes no maybe
Level access with no steps yes no maybe
Spacious kitchen yes no maybe
Specific appliances (eg sideways opening ovens) yes no maybe
Kitchen benches that can be lowered for wheelchair access yes no maybe
Specially designed bathrooms (eg plywood in walls to attach grab rails either now or in future) yes no maybe
Removable shower panel installed (so later can use for wheelchair access) yes no maybe
Lever door hardware yes no maybe
Larger lightswitches yes no maybe
Do you have an occupational therapist? yes no
Any other specific requirements or comments?
