Business Questionnaire 2 Thank you for expressing interest in Classical Feng Shui Services and Momentum Feng Shui to enhance and support your Business to help you reach maximum potential. To make the most of our time together, please fill out the questionnaire and assessment below with thought and attention to your goals. These questions are designed to help you to become more aware and create a clear focus and intention. This will also enable me to provide the most fitting ways to enhance your Business to be a nurturing environment that will help you reach your fullest potential.Questions about youFirst Name *Last Name *Email *Phone *Date of birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Business Name *Business Address *City *State/Province *ZIP / Postal Code *Country *AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweType of Business *Do you work with other people? *YesNoPlease list the people whom you work closest with including their date of birth (1 per line)What’s the primary reason you’ve decided to seek Feng Shui expertise to enhance the energy in your Business? *What year was the building built? (Exact Year is needed for accurate calculations) *Do you have a copy of the building (Architect) Floor Plan? *YesNoUpload any plans hereDrag and Drop (or) Choose FilesMax. file size: 16 MB.Please explainWhat is the approximate S.F.? *Do you own or rent your space? *How long have you been in this location? *How many staff members are employed in your Business? *Do you have a lot of repeat Business? *Is there a break room, lounge, or coffee room for the staff? *Is your location easy to find and is parking an issue for your clients coming to your Business? * *Do you know the history of your building and its previous occupants? Have they prospered and moved to a bigger space? *Are you aware of any positive or negative things that may have happened? *Since being in this location, have you noticed any changes in your business, positive or negative? *Do you feel the building requires space clearing? (this is to cleanse any old negative energy out of the area). *What is going well with your Business? *Has there been any large-scale remodeling of your space? If so, did you notice any changes after the alterations? *How do you feel when you step into the building? Do your spirits rise or fall? *What are your favorite rooms in your Business and Why? *How do you feel about the Business and the people that work with you? *Are there any common complaints among employees? If so, what are they and how can they be addressed? *Do you have adequate signage outside your Business? *YesNoIs there any soothing artwork in the area? *Our buildings can be vessels which support, nurture and help us achieve our goals: what is your Intention for your Business? *Please share anything that you feel needs to be brought to my attention including a certain area of your Business *Overall AssessmentSelect a number from 1 to 5, with 5 being the most satisfied or content and 1 being the least satisfied or content, select the number that is appropriate for the area in question. Select NA if the question does not apply..RELATIONSHIP: Does your company have good relations with other companies in your field? *12345NACAREER: Are you fulfilled by your occupation? *12345NAHELPFUL PEOPLE: Do you feel you have others in your Business that you can rely on? *12345NACREATIVITY: Is your company known as you would like to be? *12345NAFAME & REPUTATION: Is your company known as you would like to be? *12345NAFAME & REPUTATION: Is your client list as big as you would like it to be? *12345NAWEALTH: Are you satisfied with your financial situation? *12345NAKNOWLEDGE: Do you have adequate time to nurture yourself and learn new things? *12345NAHEALTH: Do you have as much energy and vitality as you would like? *12345NAWhat areas of your Business would you most like to improve and how? *What specific areas or concern would you like to especially concentrate on in the Feng Shui Consultation? *During our time together we will be working with your personal space to nourish, replenish and empower positive thoughts, affirmations and goals. Before our appointment please spend some time clearing out any clutter you have accumulated, if it is not functional, get rid of it. More thoroughly you do this, the better the results you will get in creating the energy you want for your Business. In Classical Feng Shui, remedies need to be renewed every year. An updated study is calculated in my office for nominal fee. The Clients are sent a simple floor plan marked with the remedies, to guide them on the placement for the upcoming year. Please provide a floor plan of your building or draw one as close to scale as possible, labeling rooms such as offices or cubicles, lunch room etc. This is a very important part, to ensure the accuracy of placement of remedies. Please be as accurate as possible with the floor plan and compass directions. Please provide a floor plan of your entire space or draw one as close to scale as possible, labelling rooms such as offices or cubicles, lunch room etc. This is a very important part, to ensure the accuracy of placement of remedies. Please be as accurate as possible with the floor plan and compass directions. Please complete this form within 48 hours to secure our appointment date. A 50% Deposit is required which can be paid online below. The balance of payment is due at the conclusion of our final appointment. Thank you for taking the time to fill out the questionnaire, I am looking forward to our time together. All information you provide will be held in the strictest of confidence. Services and consultations provided by Momentum Feng Shui are not intended as a substitute for the care of a licensed medical provider. I serve as a reference and guide for Feng Shui. There are no guaranteed outcomes, please keep in mind that individual results may vary, based on client interest and participation.Do you consent? *I agree.Energy Clearing (Optional)Energy Clearing plays an integral part in the outcome of achieving results in Feng Shui Consultations. If the space has been preowned, or there have been life-altering experiences (i.e. sickness, sadness or death), or patterns of arguments and distress, the energy is absorbed and stored into walls, carpet and ceiling etc. It is important to have a Space Clearing, Cleansing and Rebalancing Ritual to reset the Energy so we can start with a clean slate and embed your Intentions using the Classical Feng Shui Cures. The 3-step Ritual includes: Zenergy Chimes: programmed with a very soothing voice command to lift the stagnant and stuck energy from walls, closets, basement, garage and any other unused areas of the Business. Smoke Ritual: starting clockwise from the front door with Sage to command the newly lifted heavy energy to leave the space through open doors and windows on all levels. Rose Water: is sprinkled throughout the space in the same direction while Reciting specific Mantras unique to the client’s needs and desires to seal in the positive energy and attract more of it. All Rituals above are performed with Intention while I guide my clients to sit in a peaceful space, move forward 6 months in their desired life and embed their own Intentions into the newly freed up space energetically while I focus on inviting the Energy of the 4 P’s: Protection, Productivity, Prosperity and Positive Vibes! Business Feng Shui Consultation starts at $888 + GST (up to 3500 S.F.) Energy Clearing when added onto the Feng Shui Service as a package is $288 (otherwise $488) Deposit 50% with Energy Clearing: $588 + GST Deposit 50% with Business Feng Shui Consultation only: $444 + GSTWould you like to add on Energy Clearing Service to the Business Feng Shui Consultation for an additional $288 *Yes, please add on the Energy Clearing ServiceNo, thank you.Business Feng Shui Consultation with Energy Clearing: Pay Deposit Business Feng Shui Consultation only: Pay Deposit Will you be sending the required 50% deposit with this package? *YesNoPlease provide reasonDuring our time together we will be working with your personal space to nourish, replenish and empower positive thoughts, affirmations and goals. Before our appointment, please spend some time clearing out any clutter you have accumulated. If it is not functional, get rid of it. The more thoroughly you do this, the better the results you will get to create the energy you want for your business. In Classical Feng Shui, remedies need to be renewed every year. An updated study is calculated in my office for a nominal fee. The Clients are sent a simple floor plan marked with the remedies, to guide them on the placement for the upcoming year. Please complete this form within 24 hours and pay deposit to secure our appointment date. 50% The balance of payment is due at the conclusion of the ritual. Please note: All information you provide will be held in the strictest of confidence. Services and consultations provided by Momentum Feng Shui are not intended as a substitute for the care of a licensed medical provider. I serve as a reference and guide for Feng Shui and Energy Clearing. There are no guaranteed outcomes, please keep in mind that individual results may vary, based on client interest and participation.Do you consent? *I agree.Signature *Please type your full name as proof of signature.The Undersigned and anyone claiming on Releasor’s behalf (the “Releasor”) hereby agrees to this Waiver of Release of Liability, Indemnity, and Assumption of Risk (the “Release”) and in consideration of payment for Feng Shui and Energy Clearing Services, which includes but is not limited to providing advice, clearing the home, providing remedies, and selling products (the “Services”) hereby release and forever discharge Meena Jagpal-Paré, Momentum Feng Shui, and its affiliates, successors and assignees, officers, employees, representatives, partners, agents and anyone claiming through them (collectively, the “Releasees”), in their individual and/or corporate capacities from any and all causes of action known or unknown, which Releasor has, had, or may in the future have against any of the Releasees of and from any and all manner of actions (whether civil, criminal, administrative, investigative, or informal), causes of action, suits, arbitrations, audits, hearings, investigations, litigations, debts, accounts, due accounts, bonds, covenants, contracts, claims, demands, damages, costs, expenses, and any and all legal obligations and compensation of whatsoever kind and howsoever arising, in law or in equity, or under any statute, whether known or unknown, suspected or unsuspected (collectively, “Claims”), and which the Releasor has had, now has, or hereafter can, shall, or may have against the Releasees or any of them in respect of any matter or thing arising at or before the date hereof, and further agree that if, despite this Release, the Releasor, makes a claim against any of the Releasees, the Releasor will indemnify, save and hold harmless each of the Releasees from any litigation, expenses attorney fees, loss, liability, damage, or cost which any and all of them may incur as the result of such claim. The Releasor covenants and agrees not to, directly or indirectly, join, assist, aid, or act in concert in any manner whatsoever with any other person in the making of any Claims whatsoever against the Releasees with respect to the matters released or discharged pursuant to this Release or with respect to which the Releasor agrees not to make any Claims. The Releasor further covenants and agrees not to make or continue any Claims against any person that might be entitled to claim, pursuant to the provisions of any applicable statute or otherwise, a contribution, indemnity, or other relief over against the Releasees arising out of or in relation to the matters released or discharged pursuant to this Release. The Releasor hereby acknowledges and agrees (i) that the Services provided by the Releasee to the Releasor are not medical advice, or other forms of advice and do not in any manner or form substitute or override any medical advice, or other forms of advice; (ii) that the Releasee does not guarantee spirituality, health, success, or prosperity; (iii) the Releasor acknowledges and agrees that the Services are used at the Releasor’s own discretion, choice, and risk (iv) the Releasor hereby assumes all risks including but not limited to social and economic losses and fully accepts and assumes all such risks and responsibility for any or all losses, injury, costs, and damages which may incur as a result of the Services; and (v) to the risks of exposure related to COVID-19 while meeting with the Releasor and acknowledges and agrees that the Releasor may need to be closer than the recommended social distancing guidelines if the Releasee is requested to meet with the Releasor in person. By signing this Release, the Releasor acknowledges and confirms acceptance and willingness to accept all risks related to the Services and as a condition of receiving the Services. This Release will ensure the benefit of the Releasees, its heirs, executors, administrators and assigns and be binding upon the Releasor, its heirs, executors, administrators and assigns. The facts in respect of which this Release is made may prove to be other than or different from the facts now known by any of the Releasor or the Releasees or believed by any of them to be true. The Releasor expressly accepts and assumes the risk of the facts being different and agrees that all of the terms of this Release will be in all respects effective and not subject to termination or rescission by any discovery of any difference in facts. In the event that any provision of this Release, or part thereof, shall be found to be void or invalid by a court of competent jurisdiction, such void or invalid provision, or part thereof, shall be deemed to be severed from this Release without in any way affecting the validity, enforceability, or effect of any of the remaining provisions, or parts hereof, which shall remain in full force and effect. The Releasor acknowledges, agrees, and represents that they are of lawful age and legally competent to sign and agree to this Release. The Releasor acknowledges and confirms that the Releasor has had the opportunity to seek independent legal advice with respect to this Release or has agreed to waive its right to seek independent legal advice and that the Releasor fully understands this Release and the terms set forth herein. The laws of the province of British Columbia will govern this Release. It is expressly understood and agreed that the provisions hereof are contractual, are not merely recitals, and will be binding upon the Releasor. Any personal information collected will be used for retraining the Services. The personal information provided will be used and disclosed only for the purpose(s) for which it is collected, unless consented to otherwise, or we are authorized to do so under The Freedom of Information and Protection of Privacy Act (FIPPA).Do you consent? *I agree.Signature *Please type your full name as proof of signature. SubmitSave & Continue LaterPlease do not fill in this field. Please note that your information is saved on our server as you enter it.
