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.