CMLP Coaching Service Request Form

Your Name*

FirstLast

Your Email*

Phone Number

Street Address*

I'm interested in... (please check all that apply)*

For my...*

HomeBusiness

What step of the process are you at with your heat pump?*

Just beginning to look into heat pumpsStarting to meet with contractorsReviewing contractsSigned contracts, planning to install soonHave a recently completed installation

How old is your current heating system?

Does your home or business currently have central air conditioning?

YesNo

How old is your current AC system?

What can we help you with?

If you were to change your home’s or business's heating/cooling or water heating system, please rate the following decision factors:

	Important (select all that apply)	Most Important (select up to 2)
Adding air conditioning to my home or business
Reducing my home or business's carbon footprint
Minimizing initial cost of installing a new system
Minimizing ongoing energy costs
Minimizing changes to the aesthetics of my home or business
Other (please specify below)

If you answered "Other" to the question above, please specify:

Is there anything not mentioned above that would be important for us to know about your house?

[DEFUNCT] Is replacing your current home heating/cooling or water-heating system an urgent need because your current system is broken or in need of costly repairs?

YesNo

[DEFUNCT] We often look up buildings online to help visualize them during our conversation. Please share your address, if you’re comfortable.

[DEFUNCT] If you would like to work with a specific coach, please indicate here. We will do our best to accommodate your request given existing workloads.

Meeting Time Availability

Coach

Mondays - Fridays 10:30 AM - 4:00PM

Mondays & Tuesdays 7:15PM - 8:15PM

Other times by request

Kim Slack

Tuesdays & Thursdays 4:00PM - 6:00PM

Saturdays 11:00AM - 6:00PM

Ethan Herberman

Do you have a preference for working with a particular coach?

No preferenceYes, I have a preference

[DEFUNCT] If you do have a preference, rank the coaches in order of preference, with 1 being most preferred and 3 least preferred. We will do our best to accommodate your preference given existing workloads. Drag the coach names to reorder:

Rank the coaches in order of preference, with 1 being most preferred and 2 least preferred. We will do our best to accommodate your preference given existing workloads. Please type your ranking in the boxes below (1-2):

	Ranking
Kim Slack
Ethan Herberman

How did you hear about the coaching service?

The Customer agrees to waive any and all claims against the Town of Concord, the Concord Municipal Light Plant and Abode Energy Management, that may arise out of the consultation of Abode's coaching staff with the Customer. Any and all contracts entered into by the Customer are solely between the Customer and their Contractor or Service Provider.*

Agree

We'll let you know within 1 business day that we've assigned your request to a coach.

© 2021 HeatSmart Alliance
This work is licensed under the Creative Commons Attribution 4.0 International License.
To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

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