Consult Questionnaire

First name*

Last name*

Email*

Phone*

Address*

Company name, NGO name or Ministry name:

Preferred method of contact?*

Phone

Location of project site, address or land coordinates *

Description of project site: *

Describe the intended use of project site:*

Who will this property primarily serve? ie. ( Individual, Family, Business, Other

Identify the level of food self-reliance required:*

All

Most

Some

Little

None

Other

List your Priorities for project site, any special requests, special limitations or special needs can be listed here:*

Level of visual privacy:*

None at all

Very little

Some

A lot

Total seclusion

List your dietary restrictions and or plant and animal allergies:*

List Specifically Requested Design elements: If not sure or don't know just let us know.*

What structures exist on site that we will not be designing and or placing as part of the design:*

What drives, roads, paths, or other access on site that we will not be changing or placing as part of the design:*

Sleepy Mesquite will designing and locating: Pease check all that apply.*

Homes

Outbuildings

Fences

Earthworks

Water storage

Roads

Paths

Access

Nonvisible Plumbing

Other

List known advantages, resources, or limitations: For example: budget, soil types, friends with resources and or willing to help, no design/changes will be allow to such and such, ect. *

What are the largest known Limitations or obstacles related to this site that needs to be addressed as this design is implemented?*

What specific skills, abilities, or resources do you the client personally bring to the situation, if any that may help in the implementation of the design?*

What is your familiarity with Permaculture? *

None

Low

Medium

High

Please add any additional notes you feel the designer and or consultant should have or know about:*

We thank you for allowing us to serve your Permaculture needs.