New Home / Construction Questionnaire I am happy that you decided to design and construct your new home with Feng Shui in mind. Feng Shui is an amazing tool to use when designing and constructing a house to enhance your personal space, to support, nurture & invigorate your desires and goals. 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 become more aware and create a clear focus and intention. This will also enable me to provide the most fitting ways to recommend the design of your home to be a nurturing environment that will support your fullest potential for years to come with long-lasting and positive results. Please Note: The New Home Construction Consultation is for the assessment of the home being constructed and all emphasis will be placed to provide support in the design of the home using Feng Shui Principles and Enhancements to support health, well-being and prosperity. This does not include the Residential Feng Shui Consultation using Classical Feng Shui which is conducted once the Home is occupied and is a service on it’s own if you choose to do so.Questions about youFirst Name *Last Name *Email *Phone *Date of birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Business 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 SaharaYemenZambiaZimbabweOccupation *Questions about spouseNameSpouse's OccupationDate of birthMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Will there be other people living in the new Home (not including you or spouse)? *YesNoPlease list their name, date of birth and gender (one per line).Address of the new property *Do you have a copy of the (Architect) Floor Plan? *YesNoUpload any plans hereDrag and Drop (or) Choose FilesMax. file size: 16 MB.Please explainWhat month do you anticipate the roof to go on the House? *What will be the approximate S.F. of your living space (not including rental suites)? *Which rooms in the new design are more favorable for you (areas you will be spending more time in)? *While living in your current Home, have you noticed any changes in your life, positive or negative? *How long have you lived in your current Home? *What is your overall Intention for your new Home? What made you decide to incorporate Feng Shui into the design and construction? *On a scale of one to five with five being the most satisfied or content and one being the least satisfied or content, type the number that is appropriate for the area in question. Select NA if the question does not apply.1. Career and Life's Journey *Are you passionate about what you do for a living and does it feel fulfilling?12345NAAre you acknowledged and respected by people you work around?12345NA2. Knowledge / Wisdom / Self Cultivation *Do you feel free to grow & learn new things, and have adequate time & opportunity to nurture yourself?12345NADoes your life and schedule allow time for cultivating new knowledge and awareness?12345NA3. Family / Community *Do you have a good relationship with your family that you live with or do you feel tension or an unusual amount of arguing within your family?12345NADo you feel connected to a sense of community?12345NA4. Wealth / Prosperity / Abundance *Do you feel fortunate in your life?12345NAAre good things happening to you?12345NADo you feel you spend money wisely…or does it seem to ‘disappear’?12345NADo things show up when you need them without expectation?12345NADoes your life feel abundant?12345NA5. Fame and Reputation (how you shine your light in the world) *Do you feel good about yourself and who you are?12345NAAre you overly concerned about what people think about you?12345NADo you feel you have gifts and wisdom, light to share with others?12345NA6. Love and Relationships *Do you find it easy to love yourself, and to care for your emotional, spiritual & physical needs?12345NADo you find you are able to flow with your partner and work together on life’s everyday tasks or does communication between you and your partner seem strained most of the time?12345NAIf you are single, do you seem to attract the ‘wrong type’…or find it difficult to meet single eligible people?12345NA7. Creativity / Children / Inner Child *Are you creative and excited about life and starting new projects?12345NAIf you are a parent, is your relationship with your children rich and positive?12345NAIf you want kids, are you having trouble planning or conceiving?12345NADo you feel connected to yourself and the playfulness within you?12345NA8. Travel / Helpful People *Do you feel supported by friends and family?12345NADoes it seem that the right people show up in your life at the right time…being ‘angels’ in some way?12345NADo you travel as much as you would like?12345NADoes it feel like you’re missing opportunities to see the world?12345NA9. Health / Unity / Balance *Do you and your family enjoy good health?12345NADoes your life feel in balance and do you eat well and exercise in keeping with your goals?12345NAAfter reviewing these questions, please take a few minutes to explain any of these areas that don’t feel good to you right now. Maybe you feel they are blocked in some way, or there is something missing or hindering you from living and feeling your full potential. What would you like to change about how your life feels right now? *What areas (1-9) seem to need attention for improvement in your life? *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 Services, which includes but is not limited to providing advice, cleaning 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 is not medical advice, or other forms of advice and does 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 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 esnure to 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 a 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, and 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.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 Services, which includes but is not limited to providing advice, cleaning 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 is not medical advice, or other forms of advice and does 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 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 esnure to 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 a 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, and 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.