Trades · free template

Appliance Repair Request

Speed up appliance repair triage with appliance type, brand, symptom details and warranty status.

A ready-to-use home services & trades form for builders, electricians, plumbers and contractors: 13 questions, 2 pages, 3 conditional rules.

Questions: 13
Pages: 2
Layouts: classic · card
Conditional rules: 3
Typical time: 3 min

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Also filed under

Estimates & quotes

Live preview and test console

This is the real form. Answer it to test the 1 conditional rule — nothing is sent or stored.

Page 1 of 2 — Appliance details

Every question on this page is currently visible.

What happens after submit: nothing is stored in this preview. On your own copy, every response triggers an instant email notification and lands in your response dashboard, ready to export or forward.

Happy with it? Take a copy into your workspace — every question, rule and setting comes with it.

Who this template is for

Appliance Repair Request is built for builders, electricians, plumbers and contractors who need to scope a job and price it without a site visit for every enquiry.

Builders, electricians, plumbers and contractors working in home services & trades.
Teams who need to scope a job and price it without a site visit for every enquiry without writing code or paying for a custom build.
Anyone replacing quoting blind and travelling out for work that never lands with one structured record per enquiry.
Respondents are homeowners and site managers — the form asks them 13 questions across 2 screens.
Mobile-heavy audiences, thanks to the one-question-per-screen card layout.

Why this form is useful

It removes the cost of quoting blind and travelling out for work that never lands and turns each submission into a record your team can act on immediately.

5 questions are required, so submissions arrive complete instead of needing a follow-up email.
It collects a verified email address so replies and confirmations land.
It captures a phone number for urgent follow-up.
It pins the request to a specific date.
It captures a full postal address.
Conditional logic hides 3 questions until they are relevant — shorter forms convert better than long ones.
Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
Every response is stored, searchable and exportable, so nothing depends on one person's inbox.

How to use this template

From copy to live form is a few minutes of work, and every step is reversible.

1Press “Use this template” — a fresh copy of Appliance Repair Request lands in your workspace, ready to edit.
2Rename or delete any question, and change what is required. Nothing here is fixed.
3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
4Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
5Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.

Logic and conditions blueprint

Exactly how this form behaves as it is answered — 3 conditional rules ship with it.

Features advanced show logic: if “Is the appliance still under warranty?” is Yes, manufacturer warranty, the form dynamically exposes “Purchase date”. Otherwise that question never appears.
Features advanced show logic: if “Is the appliance still under warranty?” is Yes, extended/service plan warranty, the form dynamically exposes “Purchase date”. Otherwise that question never appears.
Features conditional validation: if “Is the appliance completely unusable or partially working?” is Completely unusable, “When did the appliance stop working?” becomes mandatory before the form can be sent.
All 3 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.

About this template

Appliance repair calls go faster when the technician knows what they're walking into before they arrive, and this form is built to capture exactly that. It opens with the appliance type and brand, since a refrigerator, dishwasher and dryer each need different diagnostic tools and, often, different technicians on a specialised team. The model number field is optional but flagged as useful, because a customer who can find it on the appliance's data plate saves a diagnostic step and lets the technician bring the likely replacement part on the first visit rather than a second trip. The symptom description is deliberately open-ended rather than a rigid multiple-choice list, since appliance faults present in inconsistent, hard-to-categorise ways — a strange noise, a smell, an error code — that a dropdown would flatten and lose detail on. Warranty status is asked directly, because a unit still under manufacturer or extended warranty often needs to be routed to an authorised service provider rather than an independent repair, which changes both the process and who pays. Whether the appliance is still usable but faulty versus completely non-functional helps set urgency, since a fridge that has stopped cooling entirely is a same-day priority in a way a slightly noisy washing machine is not.

What this form asks

Every question is editable — rename it, make it optional, or delete it entirely.

Page 1 — Appliance details

Full namerequired
Email addressrequired
Phone number
Service address
Appliance typerequired
Brand
Model number (if known)

Page 2 — Problem and warranty

Describe the problemrequired
Is the appliance completely unusable or partially working?required
When did the appliance stop working?
Is the appliance still under warranty?
Purchase date
When would you like the repair visit?

13 questions in total.

How the form changes as it's filled in

This template ships with 3 conditional rules, grouped into 3 behaviours driven by 2 questions. Everything below is already set up — edit or delete any rule once the template is in your workspace.

Driven by “Is the appliance still under warranty?”

Reveals questions
If “Is the appliance still under warranty?” is Yes, manufacturer warranty, the form reveals “Purchase date”.
Reveals questions
If “Is the appliance still under warranty?” is Yes, extended/service plan warranty, the form reveals “Purchase date”.

Driven by “Is the appliance completely unusable or partially working?”

Makes answers required
If “Is the appliance completely unusable or partially working?” is Completely unusable, “When did the appliance stop working?” becomes required before the form can be submitted.

Set it up step by step

1
Ask for the model number, but don't require it
It's genuinely useful when customers can find it, but making it mandatory blocks people who can't locate the data plate.
2
Leave the symptom field open-ended
Faults present in inconsistent ways — let the customer describe it in their own words rather than forcing a category.
3
Check warranty status before dispatch
A unit still under manufacturer warranty often needs to go back to an authorised provider, which changes your process entirely.
4
Use functional status to set urgency
A completely dead fridge is a same-day call; a noisy-but-working washer can wait for the next available slot.

Mistakes to avoid

Forcing symptoms into a rigid dropdown and losing diagnostic detail the technician actually needs.
Skipping the warranty question and taking on a job that should have gone to an authorised repair provider.
Not distinguishing completely broken from partially working, so urgent calls sit in the same queue as minor annoyances.

What it pairs with

Most teams don't run this form on its own. These are the forms and systems it sits next to.

What to do with the responses

Triage by functional status and warranty, then schedule same-day for completely non-functional appliances and standard slots for everything else.

Works in both layouts

Browse classic templates Browse card templates

Forms that overlap this one

These pages cover the same subject ground as the appliance repair request, matched on the words people actually search for.

Frequently asked questions

How is this different from the HVAC Service Request Form?

HVAC covers heating and cooling systems specifically; this form is for standalone household appliances like fridges, washers and ovens, which have different brands, parts and warranty structures.

What if the issue seems electrical rather than mechanical?

If the problem is with home wiring or the outlet itself rather than the appliance, route it to the Electrical Service Quote Form instead.

Should I still take the job if it's under warranty?

That depends on your business — many independent repair companies only take out-of-warranty jobs, so use this field to filter and redirect warranty jobs to the manufacturer.

What about appliances connected to water lines, like dishwashers?

If there's an active leak or water damage risk, treat it as urgent and consider the Plumbing Emergency Callout form if the water connection itself is the issue rather than the appliance.

Is the Appliance Repair Request template free to use?

Yes. You can preview and test Appliance Repair Request on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.

What does the Appliance Repair Request template ask for?

It asks 13 questions across 2 pages, 5 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.

Can I edit the Appliance Repair Request form after copying it?

Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.

How does the conditional logic in this home services & trades form work?

3 conditional rules ship with the template: Features advanced show logic: if “Is the appliance still under warranty?” is Yes, manufacturer warranty, the form dynamically exposes “Purchase date”. Otherwise that question never appears. Features advanced show logic: if “Is the appliance still under warranty?” is Yes, extended/service plan warranty, the form dynamically exposes “Purchase date”. Otherwise that question never appears. Features conditional validation: if “Is the appliance completely unusable or partially working?” is Completely unusable, “When did the appliance stop working?” becomes mandatory before the form can be sent. All rules are editable in the Logic tab.

Where do responses to the Appliance Repair Request form go?

Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.

Can I embed the Appliance Repair Request form on my own website?

Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.

More forms teams pair with the appliance repair request.

Related categories

All Home Services & Trades templates