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Vortex Essences Order Questionnaire

Thank you for taking the time to answer this questionnaire. The following questions will assist in gaining clarity and focus on how best our flowers essences may serve your intentions. Disclaimer: These services and products are not intended to be a substitute for medical advice or treatment. Any person with a condition requiring medical attention should consult a medical practitioner
Date

- Month - Day Year
Name *

First Name Last Name
E-mail *
1. Have you ever taken flower essences or remedies before?

Yes No
2. How did you learn about Vortex Essences?
3. What is this product testing for ?

Personal Use Blends Personal Use Individual Stock Level Options Gift Products to serve your client practice Event Formula
4. What age range is to be considered?

Under 18 18 - 25 25 - 45 45 - 65+ All of the above
5. Gender?
6. Our mother essences are stabilized in a 25% Vodka /75% pure grander water. For our records, how would you like your order bottled?
7. Tell us a little about why you are interested in using Vortex Essences?

0/600
8. What are your current top three priorities or concerns currently you would like focused on for this product testing? *

0/600
9. Vortex Essences mission statement is "Nature's Alliance for soul integration and self empowerment" . What category do you feel, best describes your first choice to align to the full spectrum vibrational assistance available?
10. Would you feel a 15 minute consultation would benefit your purchasing product?
Phone Number

- Area Code Phone Number
Enter the message as it's shown *
Should be Empty:

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Vortex Essences Order Questionnaire