Request Form for a Residential Distance Feng Shui Consultation
When an On-Site Consultation is not possible or desired, I can offer you an
alternative of a Distance Consultation. My analysis will be based on the information
you provide below.
The following questions will assist me in giving you the most complete evaluation
and help you become clearer with what you would like to accomplish from my analysis
of your space. I hope it will start your process of looking at your environment
through Feng Shui eyes. My goal is to assist you in creating an environment
you love and feels good. So have fun with this questionnaire, as there are no
right or wrong answers.
Have your Significant Other, room mate, grown children living with you, etc.(
if applicable), fill out this questionnaire separately. The more thorough and
complete your answers the more thorough my analysis will be .Thus will help
you to utilize Feng Shui enhancements to support, strengthen and activate your
environment to bring your desired results.
Please enjoy this process and answer at your own comfort level.
Date:
Name:
Address:
Home Phone: Work Phone:
Fax: E-mail:
1. Birth Information of each resident: Name, Sex, Month, Day, Year
2. How did you hear about my services?
3. Occupation/ Employer.
4. Compass direction your front door faces ( Be as accurate as possible noting
degrees)
5. Date Building was completed if known.
6. Do you live in a house, apartment, condo or other? Do you rent or own?
7. What is your understanding of Feng Shui? How did you hear about it? Have you read any books or taken classes?
8. What are your expectations from this Feng Shui consultation? Is there a specific reason you called me for this consultation?
9. Have you or anyone else experienced any particular problems since living
in this space? (ex. Financial, health, legal
problems, theft, injury, relationship issues, etc.) Be as specific as possible
10. What you believe is what you create. Think about what your sense of home
means. What is your intent to create in your environment? (Ex: A place for healing,
a place for productivity & creativity, a place of social gatherings, a quiet,
private sanctuary, a family center, home office, etc.)
11. How would you best describe the "soul" of your home? Happy - Sad
- Warm - Cold - Lonely - Empty
Stagnant - Bountiful - Harmonious - Other
12. How long have you lived/worked in this location?
13. Do you know anything of the previous occupants? Be as specific as possible.
14. What aspects of your life are working well and what aspects would you like to improve?
15. What is the first thing you see as you enter your place? How does it make
you feel?
16. Where is your least favorite area and what do you dislike about it?
17. Overall, do you like your place?
ROOMS:
18. What room(s) do you (and/or your family) spend most of your time in?
19. Do you use each room? Explain.
20. Does your furniture have any history? (Divorce, death, heirloom, etc.)
21. Do you feel your possessions are organized and in good repair? (Closets, drawers, cabinets, garage, basement, etc.)
22. What condition is your home in? Any problems with foundation, electrical, plumbing, etc.?
23. Is there anything else about your home/office you want to cover or talk
about?
Office(s):
24. Do you have a home office that you do your business from?
25. Do clients visit you at your home office?
26. Is it easy for you to focus on your work and be productive here?
27. Do you enjoy spending time here?
Other Questions:
28. Do all doors and windows open easily and in good condition?
29. How do you feel about your neighbors and neighborhood?
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LIFE SITUATIONS
(Answer those questions that apply to your situation)
HEALTH:
1) Any chronic or serious problems? How long?
2) When and how did they develop?
3) What kind of health care are you receiving for this?
4) Are you sleeping well and waking rested and refreshed?
5) Do you mostly feel balanced and healthy - physically, emotionally and mentally?
6) Do you feel (check all that apply): overwhelmed - out of control - all alone
- tired - lack of energy - unmotivated
depressed - angry - obsessive - frustrated -fearful -timid - aggressive - other_____________________________
7) Are you or your children involved in sports activities? Specify.
8) Any other health concerns?
FAMILY:
1) Any family conflict that you would like to see resolved?
2) Are you wishing to conceive or adopt a child?
3) Are your basic everyday needs satisfied? (daily expenditures -food, clothes,
shelter, etc.)
4) Any other issued related to Family you would like to address?
WEALTH:
1) Are you satisfied with you level of Abundance?
2) Do you have more difficulty attracting wealth or holding on to it?
3) What type of Abundance do you desire in your life right now?
4) How comfortable are you with wanting material prosperity?
5) Do you feel deserving of Abundance and Wealth?
6) Do you carry excess tension or a relaxed conviction in regard to wealth?
7) Do you fully believe that all that you desire is yours to receive?
8) What do you feel is preventing you from having the Abundance you desire?
FAME & REPUTATION:
1) How do you feel others perceive you?
2) How would you like to be perceived by others?
3) Do you feel sufficiently recognized, respected and appreciated at Work,
Home and in your Community?
4) What we believe determines what we create. Which of these truths fit you
most accurately?
That's just the way it is…
He who dies with the most toys wins…
Do what you love and the money will follow…
We are the world…
Other_______________________________________________________________
5) Do you want to attract and increase your public recognition?
6) Do you feel your level of determination is - Very High - High - Moderate
- Indifferent - Lacking
RELATIONSHIP
1) Do you attract loving people in your life?
2) Do you have a "best friend" that is supportive and loving?
If Single and Searching:
3) Is this area of your life a priority right now and would you like to activate
and attract a Love partner? If so, then write on a separate piece of paper (red
or pink stationary recommended) all the qualities of your Ideal Relationship.
Be as specific as possible.
4) How long has it been since you have been in a Relationship?
5) What do you feel is keeping you from having the relationship you desire?
6) Do you feel your space is welcoming for a Love partner? Emotionally and Physically?
If in a Partnership/Relationship:
7) How long?
8) What aspect of your relationship is strongest as a couple?
9) What aspect is strongest individually?
10) What aspect do you feel needs strengthening?
11) What first attracted you to each other?
12) Do you share mutual interests?
13) List some of your most enjoyable times together.
14) What would you do to create more romance in your relationship?
15) What do you need most from your partner right now?
Children & Creativity:
1) Does your creative energy feel stuck or stagnant?
2) Do you feel a lack of inspiration or motivation?
3) Does life feel like "all work and no play"? Do you play enough?
4) Does your "inner child" want more nurturing and attention?
5) What was your favorite childhood pastime?
6) List your hobbies and interest. Do you feel you make enough time for these?
7) Any issues with your children that need attention?
Helpful People & Travel:
1) Do you feel supported by those around you?
2) Do you easily attract help when needed? (helpful teacher, efficient waiter,
good cleaning Lady,
truthful salesperson, networking peers, helpful friends)
3) Is the "door of opportunity" abundant in your life right now?
4) Do you need some extra help right now? Be specific
5) Do you feel a strong connection to your spiritual/ religious guidance?
6) Are you wishing to manifest your dream vacation? Or travel more or less?
CAREER:
1) What does success mean to you?
2) Are you satisfied with your level of achievement?
3) Are you satisfied with your career/ work?
4) Are you looking to change careers or win a promotion, find a new job, etc.?
5) Are you searching for your life purpose?
6) What type of work gives you the most fulfillment?
7) If you could do "anything" you wanted to what would that be?
KNOWLEDGE & SELF CULTIVATION:
1) Are you or anyone in your family going to school or wishing to further their
education in any way?
2) Do you need more direction or clarity in any area of your life?
3) Is spirituality a part of your life?
4) Do you feel satisfied with the amount of time you allow for yourself, doing
what you want?
5) Do you meditate, pray or spend solitary time quieting your mind daily?
6) What makes you feel most at peace?
7) Are you mostly accepting or hard on yourself?
8) Do you feel a need for more quiet, introspective and peaceful time alone?
9) Are you searching for deep answers within yourself?
10) Do you appreciate yourself and value your accomplishments?
11) Are you more attracted to water and/ or dark colors than usual?
ADDITIONAL INFORMATION TO INCLUDE
Floor Plan:
Provide a drawing for each floor of the building, to scale if possible. (The
more accurate the drawing, the more accurate my evaluation can be. This should
include furniture, bathrooms (with fixtures), kitchen stove, refrigerator, sink,
who works where, who sleeps where, rooms labeled, any unusual features.
Provide drawing showing landscaping, roads, nearby buildings.
Provide a drawing showing significant structures, or features of the neighborhood
nearby (Ex: hospitals, schools, church, businesses, power lines, airplane flight
paths, bodies of water, freeways, woods, much taller buildings, etc.)
Photos :
Include photos of at least the front of your home and a view facing out from your front door. Also suggested that you include photos of each room (looking in), outside photos showing all sides of the building and landscaping, photos of anything unusual or significant inside or outside of building. Photos of anything unusual or distressing in your neighborhood. Label photos.
Consultation Fee:
$300 + $15 shipping/handing per residential dwelling. If this is for a business please contact me regarding fees.
This includes a complete analysis and recommendations on tape. A 15 minute telephone
time with further explanations and/or questions answered*. You will also receive
a personalized Feng Shui Handbook which includes your calculated Directional
Reading, Numerology of your space and Bagua Map and Enhancements.
Allow 2-3 weeks for processing.
To pay using Pay Pal use the link below.
Send by mail or email the questionaire, floorplan and photos.
After receiving notification of payment you will receive further instructions.
Or to Mail completed questionare, floorplan and photos
with check or money order email me for further instructions:
For more info or questions E-mail: ladydragonfly@sprintmail.com