PERSONAL BLEND FORM Everything here is confidential. Name * First Name Last Name Postal Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Mobile Number This will be only be used for your voicenote if applicable Order Number * You can find this on your purchase confirmation email Have you worked with Flower Essences before? YES NO Please pause for a moment and consider the past few weeks. If you had to choose a colour to associate with these weeks, what colour would you choose? * Please select any of the below that feel relevant to you Too much energy Not enough energy Overwhelm Optimism Fear about something specific Problems sleeping Hamster-wheeling thoughts Moments of gratitude Moments of grief Moments of paranoia Moments of peacefulness Confidence in something specific Anticipation Anxiety Ability to recognise stress signals and respond Boredom Your blend will aim to support you as thoroughly as possible. But if you had to choose ONE of the above as the priority concern, which would it be? * Please share as much or as little as you'd like about how a personal blend can support you at this time * Are there any specific transitions you are moving through, goals you want to reach or aspects of your life/identity that you are ready to release? Is there anything else you would like to add? How are your confidence levels? * Very good Reliable Touch and Go V shaky How about clarity? * Crystal Clear Reasonable Hit and Miss Cloudy How much spaciousness do you currently experience in your life? Too much space Frolicking when I feel like it An ok amount of space Constrained in some areas Could definitely do with more space Basically in a cupboard, no space at all How about pressure? * Intense, pressure in multiple areas of my life Pressure in one key area Pressure in moments, but manageable Constrained in some areas Not enough pressure Very relaxed Thank you for your trust We will be in touch via email as soon as possible. “NATURE DOES NOT HURRY, YET EVERYTHING IS ACCOMPLISHED” - Lao Tzu
