Spirit Rising is happy to blend a tea that is custom tailored to YOUR specific needs. Please let us know if there is a specific herb you want in your blend.
We require a first time $10 deposit on your tea, half of which is applied to your balance due when it’s ready and priced. Most of our blends cost between $4 and $12 for a 30-cup supply. We will email an invoice for the remaining balance due.
We will not share your information with anyone, ever. Health problems that you may have, or medication that you may be taking, could have an important interrelationship with the tea you will receive. Thank you for answering the following questions. We suggest you copy/paste the following into an email to us at firstname.lastname@example.org
Do you have any known plant allergies? ____________________________________________
To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to my health. It is my responsibility to check with my doctor before trying holistic remedies and to inform Spirit Rising of any changes in medical status.
SIGNATURE OF PATIENT, PARENT, or GUARDIAN
__________________________________________________ DATE ______________________
Please answer the following:
Are you taking any medications, pills, or drugs?
Please list if yes_________________________________________________________________
Are you pregnant (or trying), nursing, or have you recently given birth?
Do you have cancer? Are you undergoing chemotherapy?
Do you have any blood disorders, autoimmune disease, Leukemia?
Are you on Immune suppressants or medications changed by the liver?
Are you diabetic? Type 1 or 2?
Please list any issues or conditions that you would like a little help with.
*These statements have not been evaluated by the Food and Drug Administration. The product is not intended to diagnose, treat, cure, or prevent any disease.