When was your home built?
After 1978
Before 1978
Before 1970
I don't know
Check all rooms that have wall-to-wall carpets.
Bedrooms
Living or family rooms
Bathrooms
None
Do you wipe your feet on a doormat or remove your shoes upon entering your home?
Never
Sometimes
Always
Do any of your children have asthma?
Yes
No
No children at home
Check all toys that you purchase for your children.
Arts & crafts
Wooden toys
Cloth toys
Stuffed animals
Rubber or soft plastic toys
Hard plastic toys
Board Games