Business Questionnaire

1Personal details

2Busines details

3Overall assessment

4Consent

5Waiver of Release

I am happy that you have decided to apply Feng Shui to enhance the balance and support your Business to help you reach your 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 you
Name*
First Last
Date of birth*
Month
Day
Year
Email*
Phone*
Business Name*
Business Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you work with other people?*
- Yes
- No
Please 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?*

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 to 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 complete this form within 48 hours to secure our appointment date. 50% Deposit is required which can be sent in the form of an etransfer to info@momentumfengshui.com. Balance of payment is due at the conclusion of our appointment. Thank you for taking the time to fill out the questionnaire, I am looking forward to our time together.
Do you consent?*
I agree.
Energy Clearing plays an integral part in the outcome of achieving results in Feng Shui Consultations. If the space has been preowned, or there has 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 Service includes:

Zenergy Chimes: programmed with a very soothing voice command to lift the stagnant and stuck energy from Walls, Closets, Storage and any other unused areas of the Business.

Smudging Ceremony: Starting clockwise from the front door with Sage to command the newly lifted heavy energy to leave the space through the 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.) Then $100 for each additional 1000 S.F. .
Would you like to add on Energy Clearing Service to the Business Feng Shui Consultation*
- Yes, please add on the Energy Clearing Service
- No, thank you.
Will you be sending the required 50% deposit with this package?*
- Yes
- No
Please provide reason
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 ensure 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*
Name
This field is for validation purposes and should be left unchanged.

Business Questionnaire

Questions about you