Energy Alignment - Free Quote Questionnaire

* Your full name
* Email
* Address
*  
*  
* Postcode
* Telephone number
* Mobile number
* Occupation
* Place of Birth
* Date of Birth
* Please list the people who live with you
*
Name Relationship Age
 
* What are your reasons for considering an Energy Alignment of your space at this time? What are you hoping to achieve?
  The Space Clearing aspect of our work aims to do two things: firstly to clean and clear out the stagnant energy that has collected over a period of time and secondly to fill the clean empty space with the kind of energy you would like for your home. On the day of the Space Clearing we will be cleansing, balancing and optimising the various energy fields in your environment on a variety of levels. Before we do this you will need to spend some time getting clear about what sort of energy you want to fill your home with. This is your ‘Intention’ for your home.

You need to clearly define your Intention for your home. This is an essential first step to creating the kind of home you want e.g. do you want your home to be conducive to creativity, to be abundant and prosperous, to be full of family and friends or to be a quiet retreat?
 
* Where Intention goes, energy flows!
  My overall Intention for my home is:
 
  To aid us in our research please take a moment to observe the current condition of your environment, your health, and your relationships prior to our doing a clearing. You may wish to keep a copy of this for your own records.
  1. Plant Life
Please note the condition of the plant life in and around the property
to be cleared (please mark these from 1 to 10, with 1 being the poorest):
* Robust, Healthy
  Deep green colour
  Full, leafy
  Sparse leaves, holes in growth
  Brown or yellow leaves
  Twisted or distorted growth
  Fungus or disease on plants
  2. Animal Behaviour  
  Nervous activity in animals and/or pets? Yes No
  Barking dogs, inability to be still? Yes No
  Are there birds singing in the area? Yes No
  Pests present (ants, wasps, rats)? Yes No
  3. Health Disorders
Please tick if any of the following apply to those residing in the property
to be cleared.
  Eating/digestive problems
  Inability to sleep
  Headaches
  Fatigue
  Nausea
  Skin rashes
  Aches and pains in joints
  Inability to hold focus or concentrate
  Depression
  Feeling of heaviness
  Shortness of breath
  Pain/constriction in heart
  4. Personal relationships
Please indicate if any of the following are true in the environment
to be cleared
  Poor communication
  Lack of cooperation
  Bickering or fighting
  Irritability
  Hostility
  5. Finances
Please rate the flow of finances in your environment
  Steady, even, smooth flow
  Intermittent flow with some interruptions
  Blocked flow with obstacles and difficulties
  OTHER:
Please list any other notable situations in your environment which you feel may be affected by some form of energy disturbance.
 
  I would like:  
  Option I – Distant Work only
  Option II - Feng Shui Consultation including Distant Work
  Option III - On site Space Clearing Ceremony
  Option IV - Feng Shui Consultation from a floor plan only
  This option offers the client the opportunity to have a rudimentary analysis from the floor plan only. Recommendations can be made from observation of the house shape and compass orientation (if accurate readings are provided by the client).
  * Option - On site Space Clearing Ceremony and Feng Shui Consultation
  Whichever ‘Option’ you choose, we well need a hand drawn plan of your home incorporating any garden, (this does not have to be drawn to scale), giving us an indication of the size and layout of the rooms in proportion to one another. Please indicate this on the plan and either email us a copy or post it to: Energy Alignment, Studio 3, The Fold, Bransford, Worcs WR5 4JB
  1. front and back doors or those used most regularly
  2. location of bathroom(s),toilet(s), sink(s) and cooker
  3. windows and internal doors
  4. positioning of beds
  5. an A-Z map, ordnance survey map or similar showing where your property is located (this is helpful but not essential).
  Please give a brief history of your property and any specific problems you may have been encountering since moving in that prompted you to contact us: