Pest Control Client Intake Form

This is a fill-in form, not a calculator — there is no formula and no computed result. Type into the fields on the left and the one-page pest intake on the right updates live; print it or save it as a PDF when you're ready.

The Sample-filled toggle drops in a complete worked example (a residential roach-and-ant call with a dog to secure and a gate code); Blank clears it back to write-on lines so a fully blank sheet is a legitimate print-and-hand-fill artifact, or one you hand to the customer to complete.

Every field is optional and nothing blocks printing. The Household & safety section — pets, children under 12, pregnant/nursing or chemical sensitivities, and aquariums, beehives, or a garden — is emphasized because those facts drive which product is safe to apply and what post-treatment instructions to leave. The pest-type grid and areas-affected checklist are faster to tick than free-texting on a clipboard.

The optional quoted price is advisory only — it is never totaled, taxed, or stored — and the signature line is an acknowledgement, not a contract. Nothing you enter is saved; there is no customer list, lead pipeline, or follow-up automation here.

Intake happens before the visit, so the rest of the paperwork picks up where it stops. The pest inspection checklist worksheet pairs with it on the first visit, the pest control work order template carries the scope and the access notes out to the tech, and the pesticide application log worksheet records what was actually applied. When the intake facts turn into a priced offer, a priced quote document is built from them. A mixed shop that also sells work with no pest component can take the lead on the trade-neutral client intake form, which keeps the same address, access and job-detail spine without the pest grid.