Feng Shui Assessment

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Name *

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Last

Phone Number *

Email *

Address *

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City

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Zip Code

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Take time to reflect on both your current conditions and desired changes as you answer the following questions. Please indicate which are your priorities are at this time.
Answer as you are comfortable and submit your answers on this form.
Please complete this form 3 days prior to first our first call.
All information is kept confidential to be used for your benefit in this group.

Please advise if you are familiar with Feng Shui, have had a Feng Shui Consultation or if Feng Shui is a completely new concept. Share any Feng Shui thoughts you may have. *

The following 9 questions relate to specific areas in your life.

Life Journey / Career: This is not only about your career, but your journey in life. Are things moving easily, are you feeling frustrated or challenged, do you find a great deal of resistance? *

Relationships /Business Partnerships: This is about all relationships in your life, are you having any difficulty or specific challenges with family members, partners, co-workers. Think also about receptivity are you able to easily receive help, compliments, criticism. *

Family - Ancestors /Superiors at work - How do you relate to family, ancestors, mentors and superiors? Are your basic needs being met? *

Wealth / Fortunate Blessings /Abundance - This area relates to the Blessings in the material world, on all levels, not only financial. Are you focused or overly concerned about finances? Can you trust that all situations will work out & you will be able to work through them easily? *

Helpful Friends / Network / Clients / Your ability to freely help others - This area is about philanthropy and support. Do you have a network of people you can count on? This area is tied to the previous area of Abundance. The concept is that you are being blessed as you help others. Does this unfold effortlessly in your life? *

Joy / Creativity /Happiness/ Children - This area is related to your output & expression, including physical children. Are you using your unique talents & gifts for expressing yourself freely in life. Do you feel Joy and Happiness at this point in your life? *

Introspection / Knowledge / Self Cultivation /Spirituality - This area is about working on yourself to be the best that you can be by developing yourself. Do you find you are able to take time for yourself? This area is linked to partnership/ relationship area. When you are content with yourself, you will attract the appropriate people into your life. How content are you with yourself? *

Reputation / Fame / Illumination, Clarity in your life - This is not about being famous but how you are known in the world. How do you inspire others, how are you inspired, what are your passions? How is this reflected in your self-esteem. Consider how confident you are at this point in your life and how clear are you about your goals. *

Overall Health & Balance - Your general state of health and how you are able to lead a life that encompasses the correct amount of “balance” for your greatest good. *

Feng Shui Archetype and Relationship Assessment - Please list the birth dates of the people living together with you in your home or significant others you would like included in this part of your Feng Shui Relationship assessment. (4 people total including yourself) Month, Day and Year are most important for this purpose, time is helpful but not necessary. *

Name / Relationship / Month / Day / Year / Time: AM/PM

Feng Shui Environmental Assessment

Please advise the year was the building/ home was built if known *

How long have you lived at this current address? *

Who occupied this house prior to you and for how long? *

Why did they leave? *

Please include any significant information such as bankruptcy, divorce, illness and building history such as fire, robbery etc. *

Have there been any renovations done, if so please explain *

When you enter your home do you feel the energy rise or fall? What is your first impression? *

How do you enter your home? Front Door? Side Door? Back Door? Garage? *

What is your favorite room in your home? *

Which room are you most uncomfortable? *

Additional Information

What is your current profession? *

Which area of your life is most important to change at this time? If more than 1 please list top priority first. *

Please provide any other details that you deem necessary that will assist in making your Feng Shui assessment effective *

If you had 3 wishes what would they be: *

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Feng Shui Assessment

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