Dina the Cleaner

Home visit form · Pontypridd & surrounding areas

Fill this in so I know what matters in your home. There are no wrong answers — rooms, extras, access, and any products I should not use.

Thank you

I’ve got your form. I’ll be in touch.

So I know who to come back to.

Name

Phone

Address of the clean

Tick all that apply, then write the rooms and extras.

Regular clean One-off Deep clean End of tenancy Oven Other

How often, if regular

Rooms, extras, and anything you want included

If time is short, these are the three things that matter most.

Keys, parking, alarm, pets, bin day — anything useful on the day.

Key safe / keys left Parking on site Alarm Pets in the home

Access notes

Pet friendly, no bleach, no strong scent — tell me what to avoid.

Pet friendly please No bleach No strong scents Eco / mild products

Please do not use

Anything else

Tick all that apply. It helps me know what’s working.

Google Facebook Recommendation Estate agent Flyer / card Other

If other, or a name, please say

Website

Signed

Date

Dina the Cleaner · 07545 870581 · dinathecleaner.co.uk