Sage Living EMF Intake Forms

Client info
Electric and Magnetic Field Overview
Exterior readings
Interior readings
Interior AC Fields
Breaker assessment
Tips
Summary

Breaker assessment form:

Initial all breakers on
Initial all breakers off

Breaker 1
Name on panel:  Notes:  

Breaker 2
Name on panel:  Notes:  

Breaker 3
Name on panel:  Notes:  

Breaker 4
Name on panel:  Notes:  

Breaker 5
Name on panel:  Notes:  

Breaker 6
Name on panel:  Notes:  

Breaker 7
Name on panel:  Notes:  

Breaker 8
Name on panel:  Notes:  

Breaker 9
Name on panel:  Notes:  

Breaker 10
Name on panel:  Notes:  


Next steps

Client info
Electric and Magnetic Field Overview
Exterior readings
Interior readings
Interior AC Fields
Breaker assessment
Tips
Summary