Custom Mala Intake Form
I am so excited to be working with you in the creation of your sacred design!
Please answer all of the questions as thoroughly as possible.
Thank you.
Email address *
Contact info
Your name *
Your answer
Date of Birth *
Phone #
Your answer
What will the primary use of your Pangari Mala be?
What intention would you like your Pangar Mala to support? *
Please enter the product number
Please tell me more about why this intention is important for you at this time:
Your answer
Please list any ailments or concerns (physical, emotional) you would like crystal energy support with.
Your answer
Do you have a specific chakra you would like your design to support:
Your answer
Please list any favorite stones or stones you are drawn to:
Your answer
Favorite color(s):
Your answer
Any other specifications you have or any information you feel would be beneficial to the our sacred design process:
Your answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Will Design Lab. Report Abuse - Terms of Service