Custom Herbal
Consultation Survey

Name *

First Name

Last Name

1.) Are you searching for herbal guidance for a specific problem or issue (health/loss/misfortune/etc) or are you interested in using herbs to uplift you in your daily life but not for a specific purpose? *

I am looking for help with a specific issue

I'm not sure what I'm looking for, I'm just interested in a consult

2.) If you are looking for help for a specific issue, what is it? (check all that apply) *

health

loss

misfortune

physical/emotional distress

no specific issue

6.) What is your relationship with plants? *

I don't really have a relationship with plants, but I'd like to

I've grown and interacted with plants before

I have many plants around my home and that is important to me

Some people have pets, I have plants

7.) How have you used herbs for physical healing before? (check all that apply) *

herbal teas

herbal balms/salves

herbal soaps

herbal salts/soaks

herbal smudging/natural plant incense

homemade stocks/soups

topical applications of herbs/poultice

herbal tinctures

herbal lozenges

cooking with herbs

none of the above

other (please explain)

8.) How have you used herbs for spiritual/emotional healing before? (check all that apply) *

herbal teas

herbal smudging

herbal salts/soaks

intentional herbal healing baths

herbal oils/scents

aromatherapy

cooking with herbs

gathering herbs

gardening with herbs/plants

picking flowers

plant gazing

herbal tinctures

none of the above

other (please explain)

9.) How often do you create a sacred space for yourself? (Sacred space means doing anything that brings you peace and joy. It could mean taking a walk in nature, meditating, lighting a candle, taking a bath, or reading a book. As long as you are slowing your mind and your breathing, this is sacred space). *

I don't feel like I have time to create a sacred space for myself

Sometimes I create a sacred space for myself, but I'd like to do it more often

I am happy with the amount of sacred space I create for myself

10.) Have you ever received a message from nature? Messages can come in the form of coincidences or unexpected animal visitors. Did you have a dream about a hawk and then see one on your way to work? Did you witness an interesting insect crawling on the ground you've never seen before or see a plant blooming you never noticed before? *

No, I'm not aware of any messages, but now I'll keep my eyes peeled

I've received some messages but not many

I've received many messages from nature

I am always receiving messages from nature