Preparedness Intake — Held Advisory Group

Welcome

Your Preparedness Blueprint begins here.

A short questionnaire about your household, property, and current readiness. Your answers shape the personalized Blueprint we'll send back.

Time required

About 20 minutes. You can pause and resume — your progress is saved automatically.

What you'll need

A general sense of your household, property, and current emergency supplies. Exact details are not required at this stage.

What happens next

When you submit, we'll review your responses and prepare your customized Blueprint. You'll hear back within two business days.

Privacy

Your answers are stored on Held Advisory's own infrastructure, encrypted in transit and at rest. They are not shared with any third party.

I understand and acknowledge the above. I am proceeding with this intake voluntarily.

You must acknowledge the consent statement to continue.

About You

Who you are and where to reach you.

This information is held in a restricted, admin-only collection. It is not visible to data-entry staff or any third-party service.

Full name*

Please enter your full name.

Email*

Please enter a valid email address.

Phone

Optional. Used only if we need to follow up directly.

ZIP code*

Please enter your ZIP code.

Primary address

Street address. Used for region-specific guidance (defensible-space zones, local alerts).

Secondary property address

Optional. If you maintain a second property we should also consider in the Blueprint.

Household

Who lives in your household.

Composition shapes the Blueprint — children, seniors, and pets each add specific protocols.

Number of adults*

Number of children

Anyone aged 65 or older in the household?*

Yes No

Please select an answer.

Household staff (live-in or regular)?*

Yes No

Please select an answer.

Pets in the household?*

Yes No

Please select an answer.

Primary language at home

Optional. Used to tailor multilingual emergency communication where relevant.

Functional needs & medical

Anyone in your household with specific needs?

These answers add modules to the Blueprint covering equipment, medications, and assisted-evacuation protocols where relevant.

Anyone in the household with a disability?*

Yes No

Please select an answer.

Anyone uses medical equipment requiring power?*

Yes No

Please select an answer.

CPAP, oxygen concentrators, dialysis equipment, hospital beds, etc.

Anyone uses a wheelchair, walker, or other mobility aid?*

Yes No

Please select an answer.

Daily prescription medications in the household?*

Yes No

Please select an answer.

Any medications need refrigeration?*

Yes No

Please select an answer.

Anyone with early-stage cognitive considerations?*

Yes No

Please select an answer.

Memory, dementia, or similar — the Blueprint adds specific support protocols.

Property

About your home.

Property type, garage, backup power, and utility shutoffs shape the on-site portion of your Blueprint.

Property type*

Please select your property type.

Garage*

Please select.

Year built

Optional. Pre-1980 properties get extra fire-hardening considerations in the Blueprint.

Backup power at the property?*

Yes No

Please select an answer.

Utility shutoffs

Do you know how to shut off each of these utilities at your property?

Gas*

Yes No

Please select an answer.

Water*

Yes No

Please select an answer.

Electricity*

Yes No

Please select an answer.

Fire extinguishers in the home?*

Yes No

Please select an answer.

Evacuation readiness

If you had to leave in 15 minutes.

A snapshot of where you are today on evacuation planning. There are no wrong answers.

Do you have a written evacuation plan?*

Yes No

Please select an answer.

Family meeting points established?*

Yes No

Please select an answer.

A specific place outside your neighborhood where household members reunite if separated.

Out-of-area contact (ICofE) designated?*

Yes No

Please select an answer.

A trusted contact at least 200 miles away who serves as the household's central communication hub during emergencies.

Multiple evacuation routes mapped?*

Yes No

Please select an answer.

Fuel habit — typical tank level?*

Always half tank or more Usually half tank or more Rarely / let it run low

Please select an answer.

Supplies

What you have on hand.

Current state of go-bags, vehicle kits, and shelter-in-place supplies.

Go-bags prepared?*

Yes, complete Partially No

Please select an answer.

How many days could you shelter in place at home?*

Please select an answer.

Vehicle emergency kit?*

Yes No

Please select an answer.

Backup lighting throughout the home?*

Yes No

Please select an answer.

Flashlights, headlamps, lanterns staged in multiple rooms.

Battery-powered radio?*

Yes No

Please select an answer.

Hand-cranked or solar with NOAA weather band.

Documentation

What you've documented and digitized.

Insurance recovery and emergency response both depend on documentation. The Blueprint will walk you through closing any gaps.

Home inventory of belongings?*

Yes Partial None

Please select an answer.

A documented record of items in the home, used for insurance claims after a loss.

Photo or video documentation of high-value items?*

Yes Partial None

Please select an answer.

Receipts on file for major purchases?*

Yes Partial None

Please select an answer.

Appraisals current (within 2 years)?*

Yes Partial None

Please select an answer.

For art, jewelry, collectibles, or other items above standard insurance limits.

Where do important documents typically live today?*

Printed copies in one place One email account Multiple email accounts An accounting / bookkeeping system Scattered — no single place

Please select an answer.

Important documents digitized? *

Yes Partial None

Please select an answer.

Identity (passports, birth certs), legal (will, trust, POA), insurance policies — scanned and stored securely.

Fireproof safe for irreplaceable physical items?*

Yes No

Please select an answer.

Context

What's prompting this, and what worries you most.

These two questions help us focus the Blueprint on what matters most to you.

What concerns you most? (Check all that apply)

What's prompting this engagement? (Check all that apply)

✓

Thank you.

Your intake has been received. We'll review your responses and prepare your Preparedness Blueprint.

You'll hear back within two business days at the email you provided.

— Held Advisory Group