Personal Alchemy Elixir

I'm so pleased you would like to journey with a Stone Medicine Elixir. In order to create one that suits your individual needs, please fill in this form.

✨ Alchemy in a Bottle: Your Personalized Elixir Form

Client Details

First name

Last name

Phone

Birthday

Day

Month

Year

Multi-line address

Country/Region

Address

City

Zip / Postal code

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Intention & Focus

What area of your life do you feel needs the most support right now? (e.g., emotional healing, grounding, clarity, transformation, self-love, trust, etc.)

Do you have a specific intention or affirmation you would like to infuse into your elixir?

Are there any emotional patterns or blocks you feel ready to shift?

How do you want to feel after using this elixir?

Physical & Emotional Considerations:

Do you experience any recurring physical symptoms that you feel are connected to emotional or energetic imbalances?

Which emotions or energy states do you find yourself in most often? (e.g., anxious, overwhelmed, unmotivated, scattered, fatigued, etc.)

Are there any specific chakras, elements (Fire, Earth, Metal, Water, Wood), or organ systems (according to Chinese Medicine) that you feel drawn to working with? (Optional, for those familiar with this framework.)

Intuitive & Energetic Preferences:

Are you naturally drawn to any specific stones or colors? (Or do you have any that you strongly dislike?)

Do you have a spiritual practice or grounding ritual that helps you feel centered? (e.g., meditation, qigong, journaling, breathwork, etc.)

Would you like your elixir to have an additional vibrational essence, such as sound healing, moonlight charging, or a specific blessing? (Optional, if you offer this.)

Practical & Sensory Preferences:

Do you have any allergies or sensitivities (especially to apple cider vinegar, alcohol, or specific herbs/minerals)?

Would you prefer a mild, moderate, or strong potency for your elixir? (If applicable to your formulation method.)

How often do you intend to use the elixir? (Daily, as needed, during meditation, etc.)

Additional Notes:

Is there anything else you'd like me to know before I create your elixir?