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I want to know if you would take my Air Survey to see if you are effected by the air quality inside your home. 1) Do any these allergens bother any members of the household? ___Dust/dust mites ___Mold ___Pet Dander ___Pollen. 2) Does any member of your household wake up with sinus congestion or puffy eyes? ___Yes or ___No. 3) Does any member of the household have difficulty sleeping through the night? ___Yes or ___No. 4) Is there a musty odor in the house? ___Yes or ___No. 5) Do you have a problem with static electricity in your home or office? ___Yes or ___No. 6) Is second hand smoke or smoke odors a concern in the home? ___Yes or ___No. 7) Do cooking odors(fried foods, vegetables) linger in your home? ___Yes or ___No. 8) Are pet odors or pet dander a concern in the home? ___Cat ___Dog ___Bird __________Other 9) Do any of these chemicals bother any member of the household? ___Disinfectant Sprays ___Household Cleaners ___Perfumes/colognes __________Other. 10) Does anyone in your home hold have headaches or coughing throughout the day? ___Headaches ___Coughing ___No. If the answer to any of these questions is YES. Let me know which ones.

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