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Custom Blend Form

Custom Blend Questionnaire

Take a moment to check in with how you're feeling today. This will guide your blend selection.

Free Text

Each blend is created in small batches to ensure quality, balance, and consistency.

Name

Email

Phone

Preferred Method of Contact

Email

Phone

What would you like support with at this time? (Select all that apply)

Stress management

Anxiety / Overwhelm

Sleep Support

Focus / Clarity

Emotional balance

Energy Boost

Seasonal Discomfort

Physical Tension or discomfort

Hormonal balance

General Relaxation

Other

What would you like to feel instead?

Calm and relaxed

Clear and focused

Grounded and centered

Energized and refreshed

Rested and restored

Open / able to breathe more freely

How would your describe your current stress level?

Low

Moderate

High

Consistently elevated

When do you feel stress most?

Morning

Midday

Evening

Before sleep

Throughout the day

Which scent families do you prefer?

Fresh / herbal (eucalyptus, rosemary, mint)

Floral (lavender, geranium, ylang ylang)

Warm / sweet (vanilla, cacao, resins)

Woodsy (cedar wood, vetiver, sandalwood)

Citrus (orange, lemon, bergamot)

Unsure - I'd like guidance

Are there any scents you dislike?

Do you have any known allergies or sensitivities? (essential oils, fragrances, nuts, etc.)

Are you currently:

Pregnant or breastfeeding

Taking medications that may affect sensitivity

Under medical care for a condition

(if yes, please briefly explain)

Sensitivity & Preferences

I prefer light, subtle aromas

I enjoy more noticeable scent presence

I have sensitive skins

I prefer to avoid strong mint or eucalyptus

No known allergies

How would you like your blend prepared?

Roller (on-the-go application)

Salve (targeted support)

Body Oil Blend (multi-use)

Room Spray

Unsure - recommend for me

What is your primary intention for this blend? (Examples: calm, grounded, focused, restored)

Anything else you'd like me to know?

Opt-In

By checking, I understand this blend is not intended to diagnose, treat, or cure medical conditions.

Free Text

Each blend is thoughtfully formulated based on your responses and prepared within 24-48 hours to ensure quality and care.

Thank you for sending us your custom blend request.

We will get back to you as soon as possible.

Oops, there was an error sending your message.
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Relax. Release. Recharge.

Because wellness should feel as good as it works.

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HOURS

Mon - Fri: 9:00 am - 4:00 pm
Saturday: Appointment Only
Sunday: Closed

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