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Medicinal Tea Consultation Request

A personalized tea blend crafted through holistic and intuitive consultation.

Disclaimer: I am not a licensed medical provider. These offerings are rooted in traditional herbalism and holistic practices and are not a substitute for medical care.

🖤 Consent I understand this is not medical care and I take responsibility for my health decisions.

Signature

Name

Email

Phone

What brings you here?

( What's currently going on in your body or life that led you to seek support?)

Main Areas seeking Support

(select up to 3)

Main Areas seeking Support

How would you describe your energy most days?

When do you feel your best during the day?

Morning

Afternoon

Evening

Varies

How is your sleep?

Restful

Light / easily disturbed

Trouble falling asleep

Trouble staying asleep

Other

Do you experience any of the following regularly?

(Select all that apply)

Do you experience any of the following regularly?

How have you been feeling emotionally?

Do you ever feel energetically drained by people or environments?

Yes often

Sometimes

Rarely

Circumstantial

Do you feel like you tend to:

(Select any that resonate)

Do you feel like you tend to:

Do you have any known allergies (especially herbs, foods, medications)?

Are you currently taking any medications or herbal supplements?

Is alcohol-based tincture okay?

Yes

Are you pregnant? Breast Feeding?

Yes- Pregnant

Yes- Breast Feeding

Not Applicable

Do you menstrate?

Yes

Not Applicable

If yes to previous question, any concerns with your menstration?

What would you most love to feel or expierence after working together?

🖤 Closing This consultation is a collaborative and intuitive process. Your responses help guide the initial direction, but your custom blend will be crafted based on both your physical needs and energetic patterns.

After submitting, you'll be able to book your consultation. If you miss it, you can always book here:

https://calendly.com/ohb-bruja/30min