Flower Essence Questionnaire Name * First Name Last Name Email * Pronouns Gender Shipping address * For herbal remedies Date of Birth If you work with astrology, what is your sun, moon and rising sign? What are your primary goals for this flower essence formula? Passions/ Interests / Hobbies List any numbers, colors, songs, imagery, animals, fungi, stones and/or plants you are currently drawn to Occupation Do you feel rested upon waking? Do you have practices, tools, support systems, etc that you lean on in times of stress? If so, what helps? What is bringing you joy as of late? How can this formula hold you? Are there any themes you’re noticing in your life right now? Please share. What emotions have been coming up for you lately? Where are you feeling stuck in your life right now? Are there any herbs or flower essences you already work with? What are 1-3 of your favorite songs of the moment? Do you have a favorite quote or affirmation? Please share What media are you currently consuming? (Movies, books, podcasts, tv shows, blogs, social media) What is your favorite season? How have you been feeling in your body as of late? Do you have any health challenges? If so, what are they? What are you craving? What are you ready to release? How can this formula best support you? Is there anything else you'd like to share? Thank you!