Space Clearing Questionnaire

Space Clearing Questionnaire
Date

MonthDayYear
Date
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide information about the property/space you are requesting to have cleared by completing each of the steps/questions below to the best of your ability.
1. What is the primary reason for you choosing to have a Space Clearing? Check any that apply.

Moving into a new home or space for business and want the space cleared firstSelling a home or business space and want to optimize the energy to attract buyersOperating a business space with regular interactions with others (such as employees, customers, clients, competitors, partners, and vendors) on the physical property (This includes but is not limited to the following: business, legal, medical, healing, or counseling offices, hotels, meeting places, institutions, industrial premises).Using the space for a new intentionAfter a prolonged illness, or any transition such as divorce or death, or any intense emotionally charged event in the spaceBefore bringing a new baby into the homeSomething does not feel right, or there are apparent energetic issues with the home/building/space.Other
2. If you checked that something does not feel right, or there are apparent energetic issues with the home/building/space, please check any issues below that apply. Also, space is provided to share more information if relevant.

A vague or nagging feeling that something isn’t right with your home or workplaceA sense of resistance to be thereA feeling of being trapped, whereby it's difficult or de-energizing to try to leaveFeelings of chaos or difficulty getting your place in orderPoor sleep, constant fatigue or illnessProperty is stuck on the marketCycles of arguing or conflict at home or in the workplaceA string of bad luck, accidents, vandalism, or theft on the propertyA pattern of electric appliances breaking down around the same time or machines (especially computers) acting strangelyElectrical disturbances or oddities (such as alarms or lights going on or off)Animals acting out of sorts or exhibiting a change in behaviorSmelling strange odors without an apparent sourcePockets of cold within your spaceAn infestation of wasps or antsChildren are afraid or insist something is there, but you don’t notice anythingHaving a sensation of being touchedHearing unexplained sounds, such as walking, music, voices, or knockingExperiencing objects falling, crashing, flying, or moving inexplicably, or disappearing and reappearing someplace elseSeeing something in your peripheral vision but it disappears when looking directlySeeing a ghost or other unusual or supernatural effect/sOtherNone of these
Add additional relevant information or explanation or describe more fully any issues here.
3. Do you own or rent the home/building at this address? If you don't own it, please give the first name/s or company name of the owner/s and indicate if a management company is also involved.
4. Please indicate if this is an apartment, condo, duplex, or townhome and a description of connected abodes, units, or offices (e.g., an 8-story condo with eight units per floor, one on either side of the space to be cleared on the 5th floor).
5. What direction does your property face? (Standing in the house/building, looking out the front door, what direction do you face)? If you live in an apartment building or condo, what direction do you face as you exit your interior space?
6. What is the approximate year or time period in which the home/building was built?
7. Please describe the general 'lay-of-the-land' of the property on which your house/building is built and the surrounding area (e.g., forested, prairie, on top of a hill, in a valley, anything you think of would be helpful).
Bird's Eye View of Property

8. Please draw a rough sketch of a bird's eye view of the property, including the house/building and any outbuildings. Also, include any significant (large or unusual) trees or other plant life (grove, areas with toxic weeds like poison ivy or poison oak or thorny brambles, gardens, fruit trees, etc.), pools, ponds, lakes, rivers or marshy areas, generally plotted around the property.
- Then scan the drawing or photograph the drawing and upload it below.
File Upload of sketch of BIRD'S EYE VIEW of property

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Floor Plan

9. Please draw a roughly sketched floor plan of each floor of the house (including basement and attic) with the rooms labeled. It is not necessary to be precise.
- VERY IMPORTANT: include the placement of beds, especially where people regularly sleep.
- Label each room or specific space, including closets (Differentiate bedrooms with specific names, i.e., Master BR, Sally’s BR, Johnny’s BR, Master bath, Furnace room, etc.)
- Then scan the drawing or photograph the drawing and upload it below.
File Upload of FLOOR PLAN of each floor of property

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10. OPTIONAL: If you choose, you may photograph any or all rooms, maybe a particular room you feel would be important for me to see. (This is optional but may provide more insight regarding the energetic coherence of the room/s).
- Then upload the image/s below.
Optional images of room/s

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11. List the first names of the people who regularly spend any time in the house/building/space (including weekend only or intermittent).
12. List the types and names of any pets who reside on the property.
13. Is there any history you know about the property that feels important?
14. Do you know of any significant happenings within a mile radius of your property (e.g., an intersection that seems to have had more than its share of car accidents; any traumatic events in the area that you might be aware of; a cemetery nearby; real estate close by with conflict/controversy surrounding it)? If you don't know of any, that's OK. Don't work too hard to find this information.
15. What would you like to fulfill with or through your home/space?
16. How do you see this home/space long-term?
17. Do you have an overall intention for the home/space, or do you want to dedicate separate intentions for specific rooms or parts of the home/space?
18. What specific results do you expect to receive?
Once this questionnaire is completed, please submit it prior to your scheduled Space Clearing appointment time.
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