THANK YOU For Your Order!

You’ve taken a valuable step on your journey toward self-reliance.

Please fill out the questionnaire below to provide some basic information ahead of our scheduled consultation.

Tier 1 Pre-Consultation Questionnaire

Name *

First

Last

Email *

How Many Members Are In Your Household? *

Do You Have Pets? *

• Yes
• No

What Kind(s) and How Many? *

What type of home do you live in now? *

• Apartment/Condo
• Townhome
• Suburban Single Family
• Rural Acreage
• Other

Tell Us More *

Do You Plan On Relocating Soon? *

• Yes
• No

Where To? *

Do You Have Any Dietary Preferences/Restrictions? *

• Vegan
• Vegetarian
• Gluten Free
• Food Allergies

What Are You Allergic To? *

What Is Your Growing Zone?

Selected Value: 1

Do You Rely On a Public Utility For All of Your Electricity? *

• Yes
• No

Do You Rely On a Public Utility For All of Your Water? *

• Yes
• No

What Type of Sewer Are You Connected To? *

• Public Sewer
• Septic
• Composting Toilet

How Confident Are You In Your Basic Survival Skills?

Selected Value: 0

Finding Food/Water, Setting Up A Shelter, Firemaking, Etc.

What Are Your Greatest Areas of Concern? *

• Food
• Fire/Heat
• Water
• Safety/Security
• Shelter
• Energy/Communications

Do You Have a Bug Out Bag? *

• Yes
• No

Do You Have a Bug Out Plan? *

• Yes
• No

Submit

Tier 3 Pre-Consultation Questionnaire

Name *

First

Last

Email *

How Many Members Are In Your Household? *

Do You Have Animals? *

• Yes
• No

What Kind(s) and How Many? *

What type of home do you live in now? *

• Apartment/Condo
• Townhome
• Suburban Single Family
• Rural Acreage
• Other

Tell Us More *

Do You Plan On Relocating Soon? *

• Yes
• No

Where To? *

What is Your Approximate Roof Square Footage? *

What Is Your Growing Zone?

Selected Value: 1

Do You Rely On a Public Utility For All of Your Electricity? *

• Yes
• No

What Other Sources Do You Have? *

Do You Rely On a Public Utility For All of Your Water? *

• Yes
• No

What Other Sources Do You Have? *

What Type of Sewer Are You Connected To? *

• Public Sewer
• Septic
• Composting Toilet

Can You Disconnect From Your Utility Providers? *

• Yes
• No
• I Don't Know

Please List Your Utility Providers *

How Can You Currently Heat/Cool Your Home? *

• Electric Central Forced Air
• Gas Central Forced Air
• Radiant/Hydronic Heat
• Wood/Pellet Stove
• Air Conditioning
• Evaporative Cooler
• Other

Please Describe *

Do You Currently Have Any Outbuildings? *

• Yes
• No

Please List Them *

Do You Have a Homeowners Association or Restrictive Covenants Which Would Inhibit/Restrict Your Ability to Modify Your Property? *

• Yes
• No
• I Don't Know

Please Elaborate *

Do You or Anyone In Your Household Currently Have Health Conditions/Concerns? *

• Yes
• No

If You're Comfortable, Please Elaborate

Submit