Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Your Name *Your Email *Your Phone Number *Your Postcode *Have we visited you before? *— Select Choice —YesNoPreferred days for an appointment *MondayTuesdayWednesdayThursdayFriday* Please tick all that applyDo you need your appointment to avoid 'school run' times? *— Select Choice —YesNoDays you are NOT available NoneNOT Available MondayNOT Available TuesdayNOT Available WednesdayNOT Available ThursdayNOT Available Friday* Please tick all that applyWith reference to the availability dates at the top of the form — are there any specific dates to avoid? *Are you happy to have an appointment slot automatically allocated to you? *— Select Choice —YesNo avoid availability Type Number of chimneys to be swept *— Select Choice —123+Type of fireplace *— Select Choice —Stove/Woodburner and Flue/LinerStandard Open FireUnlined Stove/woodburnerAga/RayburnInglenook CleanBirds Nest RemovalAny other information* Please give as much information as possibleSubmit new-form-test admin September 9, 2025
