Custom Flower Essence Order Form
Your flower essence remedy will be custom blended from the original 38 flower essences of Dr. Bach.
Each dropper bottle will contain water, flower essence(s), and a small splash of brandy to deter bacterial growth. Flower essences can be taken internally, used as a mist for a room or to wear.
You will be sent a description of which flower remedies were selected for you as well as more detailed instructions on how to use them.
Please take your time in answering the questions below (small or large amounts of detail, whatever your comfort level) and know that you are being received with love.💜
If you are ordering more than one blend, please answer each question for each person to the best of your ability.
The cost of 1 custom blend is $22 (this includes shipping). Each additional bottle will be $15 (this also includes shipping).
***If you're a program member (Untethered, FEM, Cleansing Circle) or a client of Tonya's and need to add a flower essence to your larger product order, please use Tonya's product order form. If you need help with this, please contact:
Please provide your phone number:
Please provide your address for shipping (street, city, state, zip):
Please provide your first and last name (If you are ordering for others, please list your name first and then list additional names):
What is it about flower essences that drew you to them?
How would you describe what you're feeling at this moment in time? If you're ordering for others, please list each name followed with a response (For example: 1. First person's name - they're generally feeling... 2. Second person's name - often feels... etc.).
How do you want to feel? Please follow the same example format given above for multiple orders.
What is keeping you from feeling the way you want to? Please follow the same example format given above for multiple orders.
Payment and Shipping
Distance Response Muscle Testing will be utilized to create your flower essence blend(s). This will sometimes take up to a few days to complete. When your order is complete and ready to be shipped, you will receive an invoice at the email you listed above. Once your invoice is paid, your package will be sent. If you have any questions, please email
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Tonya Holcomb.