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CONCERN FORM
Client First Name
Client Last Name
Contact Email
Contact Phone
Date Observed First Concern
Date of Inspection
Property Address
Date Moved In
Date of Closing
Was Home Warranty Purchased?
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If Yes, Which Home Warranty Company?
Please Provide a Detailed Description of Incident/Condition:
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Was condition observable at the time of the inspection?
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Did you learn of this condition any time prior to closing?
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Did the seller of the property provide any type of Disclosure Form?
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If Yes, was the condition disclosed?
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Did you conduct a final walk through?
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If Yes, Date of Final Walk Through
If Yes, was the condition visable at the walk through?
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If you did not notice the condition yourself, who first brought it to your attention?
Was any action taken on this condition prior to closing?
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Were any other inspections/services performed by other service providers as of the purchase process?
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Please provide additional comments regarding your knowledge of the condition.
Name of Who Completed Form
Contact Phone of Who Completed Form
Did you obtain an estimate or proposal to correct the condition?
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Has any work been done?
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