Client Intake Form (Core) - Chimney Cleaning, Inspection and Repair

Chimney Cleaning, Inspection & Repair Client Intake Form

Professional Lead Qualification, Safety Discovery & Pre-Service System (Editable PDF + Word)

Gather the right details.
Identify real risks.
Close better, safer chimney jobs.

Most chimney service jobs don’t go wrong during the work…

They go wrong before the job even starts.

A quick phone call.
A vague description.
A rushed estimate based on assumptions.

No structure.
No real inspection insight.
No clear understanding of risk.

And the result?

• misdiagnosed chimney issues
• underpriced or incomplete jobs
• unexpected hazards during service
• customer confusion and pushback
• delays, callbacks, and liability exposure

You don’t need a basic intake sheet.

You need a Chimney Client Intake Form that turns every inquiry into a structured, professional service evaluation.

This is that system.

🔥 Built for Real Chimney Service Work — Not Generic Forms

Chimney work is unpredictable.

Every job can involve:

• different fireplace and venting systems
• hidden creosote buildup
• structural or masonry issues
• airflow and drafting problems
• water intrusion and deterioration
• safety risks that aren’t visible upfront

This intake form is built specifically for:

✔ chimney cleaning and sweeping
✔ Level 1, 2, and 3 inspections
✔ chimney and fireplace repairs
✔ venting systems (wood, gas, pellet, furnace)

It mirrors how real chimney professionals gather information before inspection and pricing begin.

Not a checklist.
A true pre-service discovery system.

👤 Client & Property Information That Sets the Foundation

Professional service starts with professional intake.

This form captures:

✔ full client contact details
✔ service address and property type
✔ occupancy status and property age

From the first interaction—you position yourself as organized, credible, and safety-focused.

🔥 Chimney & Fireplace Details (Critical for Accuracy)

Not all systems are the same—and guessing leads to mistakes.

This intake form identifies:

✔ fireplace or appliance type (wood, gas, pellet, stove, furnace venting)
✔ number of chimneys
✔ chimney location (interior, exterior, or both)
✔ last cleaning or inspection date

You walk into the job informed—not guessing.

⚠️ Current Issues & Warning Signs (Where Real Jobs Are Won)

This is where you uncover the real opportunity—and the real risk.

This form captures:

✔ smoke backing into the home
✔ strong odors from chimney
✔ poor draft performance
✔ visible creosote buildup
✔ water leaks or moisture issues
✔ cracked masonry or structural damage
✔ missing chimney cap
✔ animal intrusion or blockages

You’re not just cleaning a chimney…

You’re diagnosing a system—and pricing it correctly.

🧰 Service Request Breakdown (No More Guesswork)

Stop assuming what the customer wants.

This intake form allows you to clearly identify:

✔ inspection level requested (Level 1, 2, or 3)
✔ cleaning services needed
✔ creosote removal level
✔ repair work (cap, crown, flashing, masonry, liner, damper, waterproofing)

Everything is selected and documented before you ever quote the job.

🏠 Access & Safety Information (Eliminate On-Site Problems)

Chimney work comes with real safety risks.

This form documents:

✔ roof access availability
✔ roof type and height
✔ pets on property
✔ known safety concerns

No surprises.
No unsafe conditions.
No wasted trips.

📋 Authorization to Inspect (Protect Your Business Early)

Professional chimney companies document everything.

This form includes:

✔ client authorization to perform inspection
✔ acknowledgment of requested services
✔ signature and date fields

This protects you before the job even begins—and sets the tone for a professional process.

📄 What You Receive

✔ Chimney Client Intake Form (Fillable PDF)
✔ Chimney Client Intake Form (Editable Word .docx)

Customize it once.
Use it on every lead.

🎯 Who This Is For

Perfect for:

• chimney cleaning companies
• chimney inspection professionals
• chimney repair contractors
• fireplace and venting specialists
• masonry and restoration professionals

If you service chimneys—this should be your first step.

📈 Why Better Intake = Better Chimney Jobs

Structured intake helps you:

✔ identify real issues before arrival
✔ reduce misdiagnosis and callbacks
✔ price jobs more accurately
✔ avoid unsafe job conditions
✔ increase customer trust
✔ close higher-value work

When you gather better information…

You inspect better.
You quote better.
You operate safer.

⚔️ Stop Guessing Before You Inspect

This industry is full of:

Incomplete information.
Unexpected hazards.
Underpriced jobs.

Your intake process should eliminate all of it.

This one does.

🥷 Build a More Professional, Safer Chimney Business

If you’re serious about running a business that:

• identifies problems early
• reduces risk and liability
• controls the service process
• and consistently closes better jobs

This intake form gives you the structure to do it right.

Ask better questions.
Control the job before it starts.
Win better work.

Download it, implement it, and turn more chimney cleaning, inspection, and repair inquiries into organized, accurate, and profitable service jobs.