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
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Month
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Day
Year
Date Picker Icon
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?
Friend or Relative
Web search engine
Facebook
Wellness Universe
Linked In
E-mail
Other
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?
Male
Female
Both
6. Our mother essences are stabilized in a 25% Vodka /75% pure grander water. For our records, how would you like your order bottled?
25% Skye Vodka/75% pure grander water
40% Organic Apple Cider Vinegar/ 60% pure grander water
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?
Highest Good trusting the Vortex Team
Grace & Ease
High Vibe / Next Level
Focus & Clarity
Abundance
Partnership
Family
School Studies
Career Path
Peace & Well-Being
Physical Vitality
Emotional Stability
Positive Self Talk
Chakras & Meridians
Personal Spiritual Awareness
Multi-Dimensional Integration
Soul Agreements & Contracts
Divine Assistance & Life Purpose
10. Would you feel a 15 minute consultation would benefit your purchasing product?
Yes, lets schedule
No, thank you.
Will await your recommendations email
Phone Number
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Area Code
Phone Number
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