BaZi Questionnaire

BaZi Questionnaire

Thank you for requesting your BaZi (Chinese Astrology) consultation with me: I am excited to begin our work together! Please pre-read the questions so that you have the detailed information available to you. Your honesty and trust in sharing this information is the foundation for your successful outcome, so please consider carefully the information you provide. Upon submission, you will be redirected to the Payment Site with PayPal or Credit Card options.
  • Let's get to know each other

  • Date Format: YYYY slash MM slash DD
  • :
    Your birth hour is important ~ a consult without the hour is possible, the hour helps us hone in on specifics
  • Please provide the Town / City & Country
  • Your desires...

    A BaZi consultation will help you become more self aware so that you will make better and more informed decisions that can improve your life. For optimum results, I would like to understand why you are contacting me, so please prioritize which areas are most important to you right now. There is space provided to expand on your answers, introduce a new area of focus, and 'chat' to me.... so please 'chat' away...
  • What's on your mind...?

  • Our Agreement

    I consent to the transmission and storage of the information I have added to this consult request form.
    I understand Samantha Plovie will provide a personalized BaZi Report based on my birthdate and the information I have provided here. Follow-up conversations are included for a period of 30 days. Consults after that timeframe are invoiced as per Samantha One-on-One Consult. I permit Samantha Plovie to retain the information I provide to ensure a well-rounded consultation. I understand the BaZi report is subject to my own interpretation & application. Samantha Plovie of QiPro Sam is not responsible or liable for any damage, loss of property, harm or personal injury, resulting from this BaZi report.
  • Payment

    I agree to the consult fee as discussed with Samantha Plovie.
  • Price: $ 460.00 CAD
    I understand the BaZi consult will begin at the time specified by Samantha and once the deposit is complete. $100 is a non-refundable portion if this consult is cancelled: written notice of cancellation is required directly to Samantha Plovie.
  • $ 0.00 CAD