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What Type of Water Supply Do You Have?:

City WaterMunicipalRural (private well)Lake Water

Number Of People in Your Household:

How Does Your Water Look?:

Cloudy?Rusty?Milky?Clear?

Do you have Bad Odours On Your Cold Water Taps?:

YesNo

Do you have Bad Odours On Your Hot Water Taps?:

YesNo

What Does The Odour Smell Like?:

Occasional Bad Taste?:

YesNo

What Does The Water Taste Like?:

Which of These Conditions Apply To You?:

Scale buildup on appliances & fixturesSpotty glassware / dishesRust or dark stainsChlorine or chloromine conernsLead concernsDry skin or scalp

What Water Treatment Products Do You Currently Use?:

Water SoftenerWater Filter (whole house or under the sink)Iron FilterReverse OsmosisPitcher FilterFaucet Mounted FilterNone

What Type of Bottled Water Do You Currently Purchase?:

Single Serve bottles (500ml)Large capacity bottles (18.9L or 5 gallon)Spring WaterReverse Osmosis WaterDistilled WaterNoneOther

What Additional Water Concerns Do You Have?: