Feng Shui Consultation Application

Created June 8th, 2011 · admin ·

To apply for a Feng Shui consultation, fill in the form below and submit it through for Angela to check over. She'll then have the details she needs to quote you for your consultation and for when she performs the audit afterwards.

*(denotes required field)

First Name: *

Last Name: *

E-Mail Address: *

E-Mail Address again: *

Please enter your E-mail Address a second time.

Address *

Post or ZIP code *

Home Telephone (include country code if outside UK): *

Mobile Number:

Maiden name:

Country of birth:

Date of birth (DD/MM/YY) *

Hour of birth

Current age

Your Co-habitants

Please add details where appropriate - you can leave blank any that don't apply.

Partner's Name

Country of Birth

Date of Birth (DD/MM/YYYY)

Hour of Birth

Current Age

Number of Children:

Name, Gender, Date and Time of Birth of Each Child

Your House

My house is

Detached
Semi-Detached
Terraced
Town House
Condominium
Flat
Bungalow
Other

Year house was built:

What year did you move in?

Have you made any renovations and/or has the roof been removed? If so, please detail:

Please specify the number of:

Bedrooms

Toilets

Kitchens

Dining/Living/Other Rooms

Garages

Your Life

Please tell us about the aspects of your life you'd like to work on by selecting the appropriate boxes

Relationships

I am single and looking for either marriage or a committed relationship

I am already in a relationship but need improvements in it

Want improved husband/wife/civil partnership relationship

Suspicion of or trouble with extra marital affairs/ roaming eyes

Daughter/son relationship

Mother/father relationship

Relationships is not a problem for me right now I just want to check the future is OK

Career and Finance

I have trouble saving money

I have trouble and I'm not making enough money

I need to have better luck

I feel stuck in a dead end job

Looking for career change or advancement

Trouble at work (ie. backstabbing)

Business is not doing well

Career and Finance is not a problem for me I just like to make sure all is OK for my future

Health (please specify any conditions in the Additional Information area below)

I need more energy or suffer from lack of energy

I feel down and need to feel more positive

Trouble getting pregnant / suffered miscarriage

Low Sex drive

My health is fine and no help needed here

Your Situation

Please describe your present (and past if applicable) situation and what you would like to see happen. All information is 100% confidential and goes directly to Angela. Please do take your time to be clear as this will help Angela to understand your situation when she corresponds with you

Your Situation *

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