Fertility Case Study

Feng Shui for Fertility

Case Study Application
The information you provide is strictly confidential and is only shared with Renee Longworth for the purpose of the Fertility Feng Shui program.

Once completed and submitted, this form is sent to Renee Longworth and to the email address that you have provided. Please ensure that the email address you provide is your personal email address to ensure your confidentiality.
Full Name*

First NameLast Name
Date of birth*

MonthDayYear
Date
Partner's name

First NameLast Name
Date of birth of your partner

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
How long have you lived at this address?*
Please let me know your circumstances. If it's extensive just write the main points.*
Are you willing to make the changes that is suggested.*

Yes, whatever it takesSomewhatNo
Do you have a to-scale floor plan to use immediately*

YesNoI can have one drawn up within the week of being successful applicant
Do you give permission for Renée to use your story, process as a case study for public use on website, social media and any other promotional material*

YesNo
Would you like to remain anonymous*

YesHappy for our name and photos to be shared
Can Renée share a photo of your baby once they have arrived into the world, on her social media and website (names and dates can remain anonymous*

YesNo
Anything you would like to add?
- Application for the Feng Shui for Fertility closes on 1st Decemeber 2025
- Renée Longworth reserves the right to select the successful applicants based on her knowledge and experience.
- Renée can stop this service at anytime.
- This service is provided free of charge in exchange for being able to communicate the benefits and your story to the public for promoting this service to others.
- This service is for one home only.
Thank you for trusting me with your home and your fertility story. I am so looking forward to this adventure together!

Warmest regards

Renée Longworth x
Should be Empty:

Feng Shui for Fertility