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Your Name & Contact
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Name
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2
What are you hoping this tea blend will support?
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3
Please share more details about what you're experiencing.
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4
When do you want to drink your tea?
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Morning
Afternoon
Evening
Before bed
As needed
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5
Which flavors do you prefer? (Select all that apply)
Sweet
Minty
Floral
Earthy
Spicy/Warming
Citrus
Mild/Subtle
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6
Are there any flavors or herbs you do NOT enjoy?
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7
What are some teas or herbs you have enjoyed in the past?
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8
Do you prefer your tea hot or iced?
Hot
Iced
Either
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9
Do you want your tea to contain caffeine?
Yes
No
Either
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10
How often do you plan to drink your custom blend?
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11
Are you currently pregnant, trying to conceive, or breastfeeding?
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No
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12
Do you take any prescription or regular over-the-counter medications?
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No
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13
Do you have any known allergies to plants or herbs?
Yes
No
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14
Do you have any significant medical conditions or health concerns we should consider when selecting herbs?
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No
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15
Anything else you’d like to share with us?
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