Crystal Prescription Questionnaire
Below is the questionnaire- please answer as in-depth as possible. It asks a little about your crystal journey and your current mindset in life to gives us a little insight. These questions may seem a little invasive, but it will help us better prescribe crystals that suit you best. If there is anything that you do not feel comfortable with disclosing, please say so and move on to the next question. Remember, the deeper you go- the more we can help!

Once you fill this out and submit it, we will review it and send you your crystal prescription via email. If you have paid for the custom crystal package- you receive your crystal prescription via email and your crystal package will be sent to the address provided on this questionnaire.

Please note:
-That all information obtained will be kept confidential
-Your crystal prescription is NOT medical or health advice. ONLY suggestions & guidance for your crystal journey.
-The time frame for completion of this service can take anywhere from 3-5 days depending on how long it takes you to complete this questionnaire.
- YOU MUST COMPLETE THIS QUESTIONNAIRE WITHIN 10 DAYS OF PURCHASE******
Name *
Email *
What is your birthday? *
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DD
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YYYY
What service did you purchase? *
If you purchased the Custom Crystal Package. Provide the address you would like your package to be sent to (if you did not just put N/A). *
Have you worked with crystals before? *
How often do you use crystals? *
What is your reason for requesting a crystal prescription or crystal package? *
What is your occupation? What do you do for income? *
Where do you get your energy – what motivates you? What are you passionate about? *
What moves you to tears of joy/sorrow or makes you emotional? *
How do you like to spend your free time? What do you enjoy doing? *
What do you find works for you to feel better when you are experiencing stress? *
Where are you likely to be most irresponsible? *
What emotion (anger, fear, anxiety, etc) may make you feel most out of control? *
Do you find you learn best predominantly by listening, seeing, doing, or an equal combination of all three? *
What are your values – the things in life that are really important to you? *
What business/career opportunities you are currently not making the most/anything of?
What are three personal desires/goals you are currently not pursuing? *
Is there anyone in your life who is constantly putting you down, making you feel inadequate or whom you feel you have to tread carefully around? *
What is the biggest challenge you have in your life right now? *
What is your most urgent problem? *
What are the biggest regret you have in your life: Personal; Career/Business? *
Are there any stones that you have that you would like to know more about? *
Are there any physical ailments or health issues you would like a crystal suggestion for? *
What in particular is going on in your life that you feel needs the help of crystals? Please give details related to the items you selected in your previous response. Go as in-depth as you feel comfortable *
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