Company Name, Address, Email
Designer:
Kitchen Design Survey Form
Date:
Name:
Residence:
Jobsite Address:
Client 1:
Client 2:
Home Phone:
Home Phone:
Work Phone:
Work Phone:
Cell Phone:
Cell Phone:
Email:
Email:
Appointment
Allied Professional
Schedule:
Name:
Call When Ready:
Firm:
Times Available:
Address:
Directions:
Office Phone:
Cell Phone:
Email:
Notes:
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This information does not
constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as such. Resources such as this
business form are meant solely for informational purposes and use.
1
General Client Information
1.How long do you intend to own the jobsite residence?
2. What do you dislike most about your present kitchen?
3..What do you like most about your present kitchen?
. Sustainable design ideas important to your family:
Use of “Green” Products
eneral products made from recycled materials
Cabinets
Counters
Floors
Special water conservation products:
Wood products supplied by environmentally responsible manufacturers
Energy efficient appliances:
Sustainable design details incorporated into the plan:
Energy efficient lighting systems:
Areas for recycling waste incorporated into the plan:
.
Building Materials
?
. How many household members li e in the ho e
Age
Name
. erson l in or
Handed
R
L
R
L
R
L
R
L
R
L
R
L
Height
Physical Limitations/Mobility Aids
tion bout the itchen:
hat type of cooking is done in the home
ho is the main cook
o you share or rotate cooks
ho does most of the cleanup
Are there any specialty appliances needed
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This information does not
constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as such. Resources such as this
business form are meant solely for informational purposes and use.
2
. How does the
ily use the itchen or e ls t ho e
daily heat & serve meals
daily “from scratch” meals
daily “bring in” meals
weekend family meals
ethnic or specialty cooking (please specify)
weekend “quantity” cooking
What type of foods is the family cooking?
. h t ty e o se ting would you li e
number of seated diners
separate table-
counter
30” counter height
36” counter height
2” counter height
ht
1 . Do you have any furniture or ite s you would li e to consider in the design o the kitchen?
11. o you entert in re uently
1 . h t other cti ities will t e l ce in your itchen
Hobbies:
Medicine Center / Use
Children Playing
ating
Laundry
Message Center
Study/Homework
ro ing lants
Liquor/Wine Storage
Planning Desk
TV /Radio/Media/CD
Computer sage:
3. h t is your cycle or sho ing or ood
Weekly
Twice Weekly
Daily
Bi-weekly
Monthly
1 . Style of Home (Exterior):
Ye
Yes
1 . s the ho e historic
No
What
Wh time period?
Are there historic covenants or restrictions affecting
cti the home?
1 . s the ho e
rt o
Ho eowner s ssoci tion
Ye
Yes
No
Is there Homeowner’s Association covenants or restrictions affecting the home?
Ye
Yes
No
1 . tyle o Ho e nterior
Colors:
Materials:
Furniture:
Accessories:
Other:
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This information does not
constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as such. Resources such as this
business form are meant solely for informational purposes and use.
Source
Cabinetry
Key: KS= Kitchen Specialist
Use Existing
O= Owner OA= Owners Agent
Construction
Base
Yes
Wall
Tall
Island
No
Furnished by
KS
Face Material
Framed
Wood-Species
Frameless
Laminate
Installed by
O/OA
Base
KS
Wall
O/OA
Tall
Island
Paint
Full Overlay
Acrylic
Partial Overlay
Metal
Lip
Inset
Other
Door Style:
Hardware
Knob
Pull
Color and Finish:
Finger Pull
Design Information
Special Details:
2020 NKBA B
Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This information does not
constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as such. Resources such as this
business form are meant solely for informational purposes and use.
Soffit / Fascia
Use Existing
Yes
Furnished by
No
KS
Installed by
O/OA
KS
Fascia / Soffit Construction
Open
Extended
O/OA
Fascia / Soffit Materials
Flush
Recessed
Remove
To Ceiling
Wallpaper
Wood
Display Rail
Paint
Lighted
Other
Other
Countertops
Use Existing
No
Yes
Material
KS
Kitchen
Ceramic Tile
Furnished by
O/OA
Island
Other
Installed by
KS
Edge Treatment
O/OA
Island
Other
Thickness
Size
Shape:
Grout
Bevel
Concrete
Ogee
Engineered Stone
(quartz)
Granite
Bull Nose
Limestone
Square
Marble
Eased
Plastic Laminate
Kitchen
Full
½ Full
Contrast Color
Stainless Steel
Other
Soapstone
Backsplash
Solid Surface
Match to Counter
Wood
Full Height
Other
Endsplash 4” High
Other
Color or Pattern:
Other
Details:
2020 NKBA B
Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This information does not
constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as such. Resources such as this
business form are meant solely for informational purposes and use.
Cornice
Sink
Use Existing
Yes
No KS
Material
Composite
Enamel / Cast Iron
Porcelain / Steel
Stainless Steel
Solid Surface
Other
Other
Number of Bowls
One
Two
Same Size
Large / Small
Three
Color
Sink #1
Furnished by
O/OA
Sink #2
Installed by
Sink #3
Sink #1
Sink #2
Sink #3
Sink #1
Sink #2
Sink #3
Details:
KS
Mounting
Self-Rimming
Under-Mount
Integral
Counter Section
Apron
Other
Special Features
Drainboard L
Drainboard R
Strainer
Accessories
1 Type
2 inish
3
4
5
Sink #1
O/OA
Sink #2
Sink #3
Sink #1
Sink #2
Sink #3
Installed by
O/OA
Sink #1
Sink #2
Sink #3
Sink #1
Sink #2
Sink#3
Faucet
Use Existing
Yes
No
Material
Brass
Chrome
Epoxy-Color
Gold
Brushed Nickel
Pewter
Stainless Steel
Other
KS
Sink #1
Furnished by
O/OA
Sink #2
Sink #3
KS
Style / Features
One Handle L R
Two-Handles
Bridge Type
Pot Filler
Goose Neck
Pull-out Spray
Automatic Operation
Other Features
Other Bo l
Other i e
Other
Other
Separate Spray
Instant Hot
Water Filter
Dishwasher Air Gap
Dispensers
Use Existing
Yes
No
Type
Dish Detergent
KS
Sink #1
Furnished by
O/OA
Sink #2
Sink #3
KS
Type
Hand Soap
Installed by
O/OA
Sink #1
Sink #2
Sink #3
Hand Lotion
Lighting Systems
Use Existing
Yes
No KS
General
Furnished by
O/OA
Installed by
O/OA
KS
Ambient
Halogen
Fluorescent
Xenon
Halogen
Fluorescent
Xenon
Halogen
Fluorescent
Xenon
Decorative
Cove
Track
Under Cabinet
Recessed
Pendant
Surface mtd.
Halogen
Fluorescent
Other
Other
Other
2020 NKBA B
Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This information does not
constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as such. Resources such as this
business form are meant solely for informational purposes and use.
Appliance & Fixture Specifications - Option 1
(Option 1 to be used by design professionals who select specific appliances for the client.)
Size
Color
Item / Description
Surface Cooking
Range
Config.
Fuel
Cooktop
Config.
Rangetop
Config.
Surface Ventilation
Fuel
Fuel
Remote Blower
Interior Blower
Recirculate
CFM
Height
Transition
Island
Wall Mounted
Hood:
Manufacturer
Model #
Notes
Configuration: P=Professional CT=Cooktop (controls on top)
RT=Range Top (controls on front)
Style: DI = Drop-in FS=Freestanding SI = Slide-in
Duct Cover:
Hood Liner and/or Blower:
Down Draft:
Micro Combo:
Oven Cooking
Oven:
Single
Double
Oven / Microwave Combo
Warming Drawer
Microwave and Specialty Ovens
Microwave
Quantity:
Configuration: CT= Countertop BI= Built-In OTR= Over The Range
Confiig.
Trim Kit:
Refrigeration
Other:
Configuration: SxS= Side-by-Side UCDR= Undercounter Drawers UCD= Undercounter Door L/R TF= Top Freezer BF=Bottom Freezer
Style: Free Standing BI= Built-In (Standard) IN=Built-In (Integrated) AR=All Refrigerator AF=All Freezer
Refrig. Config
Style:
Refrig. Config
Style:
Refrig. Config
Style:
Front Panel
Dishwasher / Compactor
Style: ST= Standard IN= Integrated SI= Semi-Integrated DR=Drawer
Dishwasher
Style
Compactor
Style
Front Panel
Water Products
Configuration: S= Single D=Double BL= Big and Little
Sink #1
Config
Sink #2
Config
Style: UM= Undermount TM= Top Mount IN= Intergral AP= Apron
C=Counter Section
Style
Faucet:
Style
Faucet:
Sink #3
Config
Style
Faucet:
Sink Accessories:
Instant Hot:
Water Filter:
Garbage Disposer
Miscellaneous
Quantity
(Laundry, BBQ / Outdoor Equip, Intercom, Vacuum, Espresso, Ironing Center, Water Softener, Warranty,
etc.)
End Appliance & Fixture Specifications - Option 1
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This
information does not constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as
such. Resources such as this business form are meant solely for informational purposes and use.
Appliance & Fixture Specifications - Option 2
(Option 2 is used by designers who gather all generic appliance info., rather than specifying specific appliances.)
Range
Use Existing
Yes
No
Cooktop / Range Top
Furnished by
O/OA
KS
New
Existing Finish:
Fuel
Electricity
Propane
Type
Free-Standing 
Integrated
Electric Surface Units
Conventional Coil 
Magnetic Induction 
Installed by
O/OA
KS
Use Existing
Yes
No
Size:
Drop-In 
Slide-In
Professional Style
Sealed Glass
Ceramic 
Thermostatic
Controlled Unit


Dual Size Unit 
Gas Surface Units
Open-Air (Conventional) 
Sealed 
High BTU 
Surface Controls

Electronic 
Conventional Knob 
Other Cooking Surface Features

Griddle 
Grill 
Oven Features
Electric Oven 
Gas Oven 
Broiler 
Convection Oven 
Pyrolytic (SelfOther
Cleaning)
Controls:
Conventional Knob
Electronic 
Other Range Features
Furnished by
O/OA
New Existing Finish:
Fuel
Electricity
Propane
Type
Free-Standing
Integrated
Electric Surface Units
Conventional Coil
Natural Gas
Solid Disk
(Electric Hob)
Halogen Unit 
KS
KS
Installed by
O/OA
Size:
Natural Gas
Drop-In
Slide-In
Professional Style
Solid Disk
(Electric Hob)
Halogen Unit
Magnetic Induction
Dual Size Unit
Gas Surface Units
Open-Air (Conventional)
Surface Controls
Electronic
Conventional Knob
Other Cooking Surface Features
Sealed Glass
Ceramic
Thermostatic
Controlled Unit
Sealed
High BTU
Griddle
Grill

Ventilation System
Use Existing
Yes
No
KS
Updraft / Canopy
Exhaust
Hood
Match to Cooktop 
Custom Design 
Furnished by
O/OA
Installed by
O/OA
KS
Downdraft / Proximity
Surface Mount
Pop-Up (Behind Cooktop)
Ventilation System Installation
New Ductwork Needed
Space to Run Ductwork
Recirculating
Match to Cabinetry 
Slim Line / Telescoping 
Ovens
Use Existing
Yes
No
Pop-Up (Next to Cooktop)
Duct Termination
Microwave Oven
KS
Furnished by
O/OA
KS
Installed by
O/OA
Use Existing
Yes
No
Conventional
New
Existing Finish:
Configuration
KS
Furnished by
O/OA
KS
Installed by
O/OA
Microwave Oven
Size:

Single
Double
Combo Micro / Oven 
Under-Counter Installation
Wall Installation
Steam Cooking 
High-Speed Cooking
Convection CookingConvection CookingGas
elective
Pyrolytic (Self-Cleaning)
Controls:
Conventional Knob
Electronic 
Other Features
New
Existing Finish:
Installation
Free-Standing
Configuration
Microwave-Ventilation Combo
Microwave-Convection Cooking
Features
Browning Element
Size:
Boxed/Built-In

Integrated
Professional Style
Microwave-Light Cooking
Turntable
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This
information does not constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as
such. Resources such as this business form are meant solely for informational purposes and use.
8
Refrigerator / Freezer
Use Existing
Yes
Furnished by
No
KS
Installed by
O/OA
Type
Single Door Refrigerator
Single Door Freezer
Refrigerator / Freezer:
Side by Side
Top Mount
Bottom Mount
Undercounter
Modular Units:
Refrigerator Drawers
Freezer Drawers
Freezer:
Upright
Chest
Installation
Free-Standing
Boxed-In
Integrated
Under-Counter
Decorative Panels
#1
KS
#2
#3
O/OA
Features
Ice Maker
Ice Dispenser (Door)
#1
#2
#3
#1
#2
#3
Mini-Door Access
Water Disp. (Outside)
LCD Screen
Other Features
#1
#2
#3
Other Cooling Appliances
Ice Maker
Wine Storage
Dishwasher
Use Existing
Yes
Furnished by
No
Type
Door
Drawers
Installation
Built-In
Integrated with Decorative
Panel to Match Cabinets
Stainless Steel
Color Front
Installed by
KS
O/OA
KS
O/OA
#1
#2
#1
#2
Interior Finish
Plastic
Stainless
Dishwasher Features
Adjustable Shelves
Flatware Trays
#1
#2
#1
#2
Multiple Racks
Special Cycles
Stem Storage
Other Clean-Up Appliances
Use Existing
Yes
No
Furnished by
KS
Type
Disposer:
Batch Feed
Continuous Feed
Installed by
O/OA
#1
#2
KS
#3
O/OA
Type
Trash Compactor
#1
#2
#3
Other Appliances
Use Existing
Yes
No
Furnished by
KS
Type:
Built –In Small Appliances
Radio
O/OA
Computer
Telephone
Intercom
Television
Installed by
KS
VCR / DVD
Other:
O/OA
Warming Drawer
Other:
Washer / Dryer
Other:
End of Appliance & Fixture Specifications - Option 2
2020 NKBA B
Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This information does not
constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as such. Resources such as this
business form are meant solely for informational purposes and use.
Flooring
Use Existing
Yes
No
Furnished by
O/OA
KS
Installed by
KS
Floor Preparation
O/OA
Floor
Removal:
Material
Leveling:
Bamboo
Carpet
Ceramic Tile
Cork
Shim:
Laminate
Linoleum
Vinyl-Sheet
Vinyl-Tile
Subfloor Material:
Wood
Wood-Engineered
Stone
Other:
Underlayment:
Color or Pattern:
Baseboard Under Trim:
Describe:
Transition Treatment
Windows
Use Existing
Yes
No
Interior Wall Patch:
Window #
KS
Check all that apply.
Slider = S Casement = C Double-Hung = DH Skylight = SL
Bow = BO
Bay = BA
Vinyl = V Aluminum = A
Aluminum Clad = AC Wood = W Glass Block = GB
Furnished by
Installed by
O/OA
KS
O/OA
Exterior Wall Patch:
Sink Vent Relocation:
Configuration
Doors
Use Existing
Yes
No
KS
Door #
Configuration
Size
Screen
Screen:
Yes
No
Screen:
Yes
No
Screen:
Yes
No
Screen:
Yes
No
Screen:
Yes
No
Relocate
Yes
No
Check all that apply.
Bi-Fold = BF Slider = S Pocket = P French = F Swing = SW
Solid Core = SC Steel = ST Hollow Core = HC
Furnished by
Installed by
O/OA
KS
O/OA
Hinge
Size
Screen
L
R
Screen:
Yes
No
L
R
Screen:
Yes
No
L
R
Screen:
Yes
No
L
R
Screen:
Yes
No
L
R
Screen:
Yes
No
L
R
Screen:
Yes
No
Relocate: Y es
No
Hardware Finish:
Passage
Privacy
Knob
Lever
(Note: Door hinging determined as you face door and open toward you.)
Surfaces
Use Existing
Yes
No
Wall Preparation
KS
New Plaster/Drywall
Wall Finish
Paint
Ceiling Finish
Paint
Ceiling Preparation
New Plaster/Drywall
Furnished by
O/OA
Clean
Wallpaper
Wallpaper
Installed by
KS
Remove Exist. Covering:
Tile
Other:
Suspended
Clean
Blinds
Vaulted
Patch Exist
Other:
Window Treatment
O/OA
Patch Exist
Other:
Remove Exist. Covering:
Repairs:
Fabric
Shutters
Other:
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This
information does not constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as
such. Resources such as this business form are meant solely for informational purposes and use.
10
Source
Construction
Use
Existing
HVAC
Yes
HVAC
No
Details:
eating ystem
Category
Responsibility
KS
O/OA
Air Conditioning System Age:
Planned Improvements:
Yes
uel ource Type
Cooling entilation Relocate, Replace
No
Heating System Age:
Planned Improvements:
isting
Cooking Ventilation Ductwork Age:
Planned Improvements:
Electrical Work
Yes
No
Details:
ire Type:
New Service Panel:
Code Updates:
Modifications to Exist. Service:
pen Circuits
Plumbing:
Yes
No
New Drainage Requirements:
ater upply
New Vent Stack Requirements:
aste ipe Type
General Carpentry
New Rough-In Requirements:
Modifications to Exist. Lines:
Yes
No
isting all
Reconstruction Work (Except as previously noted.)
isting Trim
Windows:
Yes
No
Removal of indo s
Doors:
Interior Walls:
Removal of Ceiling
Exterior Walls:
Removal of loor Covering
Removal of offitts
Cabinet Install. / Woodworking Trim Install:
Removal of ebris
Miscellaneous Work
Details:
Yes
No
Building Permit(s):
Structural Engineering / Architectural Fees:
nspection ees
Other:
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This
information does not constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as
such. Resources such as this business form are meant solely for informational purposes and use.
1
Existing Construction Details- continued
1 . ondition o
Surface Walls
Floors:
Ceilings:
Soffit / Fascia:
(Parallel Wall to Within ¾)
Squareness of Corners:
Is there any hazardous material to be removed?
1 . Construction of Floor:
2 . irection o
loor oists
21. Exterior:
Brick
22. Interior:
Drywall
3.
indows
Sliders
y eo
oo
Stucco
Aluminum
Yes
Wood
Wood
Lath & Plaster
Perpendicular to Longest Kitchen Wall Joist Height:
Other:
Other:
Yes
No Doors Can Be Relocated:
Double Hung
City Service
2 . Sewage System:
.
Parallel to Longest Kitchen Wall
n e eloc ted
2 . Windows:
Frame
Slab
Skylights
Septic System
No Walls Can Be Relocated:
Greenhouse
Casement
Bow/Bay
Yes
No
Other:
Other:
teri l
Age of Roof:
Access:
Can Equipment Fit Into The Room?
Basement:
Crawl Space:
Attic:
Material Storage:
Trash Collection Area:
HVAC: Describe Existing System: Heating:
Ventilation:
Air Conditioning:
Plumbing:
Location of Existing Vent Stack:
Type of Trap:
Add Additional Line:
Electrical
GFCI Existing:
Yes
New Wiring Access:
No
Hard
Existing Electrical Service Capacity:
.
oo
Average
Easy
Number of Circuits Open for Expansion:
Number of 120V Circuits:
Number of 240V Circuits:
elow itchen
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This
information does not constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as
such. Resources such as this business form are meant solely for informational purposes and use.
12
C
No.
A
B
Doors
D
E
F
G
Existing Construction Details
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This
information does not constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as
such. Resources such as this business form are meant solely for informational purposes and use.
1
D
No.
A
B
C
Windows
E
F
G
H
I
Existing Construction Details (continued)
©2020 NKBA BMF8 Copyright 2020 by National Kitchen and Bath Association. NKBA is providing this material for general information only. This
information does not constitute the provision of legal advice, accounting services, or professional consulting of any kind, nor should it be construed as
such. Resources such as this business form are meant solely for informational purposes and use.
1