Questionnaire for Residential Feng Shui Consultation - Reiko Home by Reiko Gomez - Feng Shui Designer

Full Name

First

Last

Birthday

Address of building (include zip code)

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Phone number

Email

If there are additional family members in the house, please list their full names and birthdays (month/day/year)

Year house was built (if known)

Direction front door of house faces (if known)

What would you like to get out of a feng Shui consultation?

What are your goals in the following areas?

1. Health/ Body

2. Romantic Relationships

3. Family relationships and Children

4. Friendships

5. Career

6. Wealth/ Financial Security

7. Fame/ Public Recognition or Reputation

8. Education/ Self-development/ Spiritual Growth

Which of the above areas are most important to address right now?

What do you consider your strengths?

Where do you feel you "get stuck" in life?

what in your life, have you been putting up with (either unwilling or unable to change)?

What, in your home, have you been putting up with (either unwilling or unable to change)?

When you think of your home 5 years from now, what would you like to see change?

When you think of your life 5 years from now, what would you like to see change?

Do you have a long-held dream that you would like extra support around?

How long do you see yourself living in your current home?

Is there anything else you would like to share? (All information is confidential)

My commitment to you:

I am committed to helping you achieve your goals and live your dream by providing the best Feng Shui analysis possible. I will do my best to listen to you and your needs and provide specific recommendations that will produce powerful results.

Your analysis will include an advanced Feng Shui reading of your space, analysis of the layout, and detailed recommendations for optimal health, wealth and harmonious relationships.

While my goal is to help you get the most from your consultation, I cannot promise specific results nor be held responsible for what happens within a space or to its occupants after my recommendations have been implemented.

By returning this questionnaire along with payment, you confirm that you have read and agree to the terms of our working relationship. Thank you for choosing to work with me, and I look forward to getting started!

Documents required prior to consultation

1. Completed Feng Shui Questionnaire
2. Full payment
3. Floor plan of the home
4. Photos of house interior and exterior
(Interior pics: take wide shots of key rooms, standing as far back as possible. Include the view from front door looking inside. Exterior pics: take wide shot of front of house, back of house. Include the view from front door looking outside.)

Upload docs

Click or drag files to this area to upload.

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What are your goals in the following areas?

My commitment to you:

Documents required prior to consultation

Title

Get into the Flow