Water Quality Questionnaire

Water Quality Evaluation

Your water quality is an important first step to determining your needs for a water filter or a water softener. We can help you on your way to having the best water for your family. 

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Where Does Your Water Come From? *

• Municipal Water
• Private Well
• Spring or Stream
• Other

Are there light-colored stains or deposits on your sinks, toilets, fixtures, or appliances? *

• Yes
• No
• Maybe

Are there rust-colored or brownish stains on your sinks, toilets, fixtures, or appliances? *

• Yes
• No
• Maybe

Does the water have an odor similar to rotten eggs? *

• Yes
• No
• Maybe

Is there sediment, sand, or particulate matter in your water? *

• Yes
• No
• Maybe

Do you have low or fluctuating water pressure? *

• Yes
• No
• Maybe

If this is for a residence, how many bathrooms are there? *

• 1-2
• 3 or more
• Not a residence

How many people reside there? *

• 1-2
• 3-4
• More than 4
• Not a residence

Do you think your water may be contaminated or hazardous to your health? *

• Yes
• No
• Maybe

Have you tested your water or had it tested by a laboratory? *

• Yes
• No
• Maybe

light-colored (optional) tested

Are you interested in treating all of the water or just the drinking water? *

• All of it
• Just the drinking water

What is your biggest worry or concern?

Provide any additional observations about the water quality.

Name *

First

Last

Zip Code (optional)

Email *

Phone Number *

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