Flood Remediation Screening
Was your home flooded by the recent storms on July 6-9, 2021?
Please complete this screening if you need assistance with drying out your home.
Want to volunteer to help others with flood remediation? Please fill out our volunteer form at
If you need assistance completing this form, please contact 361-450-0131 or
Your Full Name
Spouse/Partner's Full Name (if applicable)
Physical Address (include City, State, Zip)
Mailing Address (include City, State, Zip)
Do you Rent or Own?
What type of structure is the home?
Please describe in as much detail as possible what is needed right now to make your home safe and dry.
How did you hear about us?
A copy of your responses will be emailed to the address you provided.
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