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EMF Survey Enquiry Form
Name
Email
Contact Number
Postcode
House Occupants
1 Person
2 People
3 People
4 People
5 People
6 People
More than 6 People
Household Age Range
0 - 100
0 - 60
25 - 55
Type of Property
House
Apartment
Terrace
Detached
Semi-Detached
Bungalow
Other
Level of Electrosensitivity
Sensitive
Very Sensitive
Extremely Sensitive
From 0 to 10 What is your level of understanding of EMF health issues:
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1
2
3
4
5
6
7
8
9
10
What Are Your Expectations?
Improve Health
Improve Immunity
Peace Of Mind
Improve Sleep
All Of Them
Do you have any monitoring equipment or shielding products?
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