PEPN-HEART™ Pre-Assessment Intake Property Information Property Address Name * Email * Phone Occupant Health & Indicators Symptoms improve when away? No Yes Worse in specific rooms? No Yes Which rooms? Healthcare provider recommended evaluation? No Yes Building Profile Age of Home Square Footage Foundation Type Slab Crawlspace Basement Moisture & Water History Water damage history? No Yes Describe locations & timeline Current moisture concerns? No Yes HVAC & Air Distribution Number of HVAC systems HVAC issues? No Yes Filtration Type Basic (1–4 MERV) Mid (5–10 MERV) High (11+ MERV) Unknown Exposure Pathway Indicators Excess dust accumulation? No Yes High dust reservoir areas? No Yes Interventions & History Air purification in use? No Yes Brand / Type Previous remediation or testing? No Yes Describe Submit Intake This intake is for environmental exposure screening purposes only. It is not a mold assessment or medical evaluation.
