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Healthy Home Check-up Registration Form

Introduction

Through generous support from the City of Seattle, the American Lung Association is able to offer residents of Seattle a FREE Healthy Home Check-up.  

Please complete this registration form to see if you are eligible based on your home location and help us learn a little bit more about you and your home environment. Once you complete this online form and if you are within our service area, a staff person will reach out to you via telephone to schedule an in-person visit and answer any questions. If you live outside of our service area, you will be redirected to our Do-it-Yourself materials.

All questions on this form are optional, except for those marked with an asterisk (*). These questions are required because they provide information necessary for us to follow-up with you and best serve you and your family. Any personal information that you provide will only be shared with the Lung Association program staff and will be put in a secure database. Please be sure that you click through the entire survey and hit submit, even if you skip some questions.

If you would prefer to complete this registration form over the phone, please contact Sydney Boothe at (206) 512-3279.