Requested Consultation Date
Requested Consultation Time
Name
Street Address
City
State
Zip Code
Home Phone	(no dashes)
Cell Phone	(no dashes)
Email
Website
Do you have an office or operate a business from home	Office Business N/A
Name and Type of Business	Name Type
Are you	Married Married with Children Single Living With Someone
How many people live in your home?
What type of home do you live in?	Single Family Home Condo Apartment
What is the square footage
What are the birthdates and names of all living in home?
How did you hear about Feng Shui By Design?
Have you ever had a Feng Shui consultation before?	Yes No
Briefly describe your present situation and what you would like to accomplish with this consultation
How long have you lived in your home?
Where did you live before?
Why did you move?
Describe the experience of finding your home
How old is your home?
Is anything broken, not working properly or in need of any type of repair? If so, for how long?
Do you know who lived there before you? What was their life like? Why did they leave?
What is the history of the home?
In a few words, briefly describe your neighborhood
Are there any schools, churches, hospitals, large commercial properties, parks, lakes, playgrounds, major highways or electrical transformers near you?
How would you describe your life since you moved into this home? While answering, give some consideration to: health and well being, career, knowledge, family, wealth, fame/reputation, marriage/relationships/parnerships, children/creativity, helpful people/travel
In what areas of your life are you most satisfied?
In what areas of your life are you least satisfied?
What are your top three goals for this Feng Shui Consultation?	Goal 1 Goal 2 Goal 3
Is there any other reason for your consultation?