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Quick Custom Formula

Get a personalized herbal formula created specifically for your current health needs via questionnaire.

How It Works

1. Complete the Health Questionnaire

Share your current health goal and any relevant background. This helps me understand your constitution and what your body needs support with right now.

2. Choose Your Option at Checkout

Select whether you’d like your formula as a Digital Only recommendation ($25) or paired with a shipped tincture, tea blend, or topical product. ($40+)

3. Receive Your Custom Formula

Your personalized herbal formula will be designed and emailed within 2 business days. If you selected a physical product, I’ll craft and ship it directly to you once the formula is finalized.

Questionnaire:

This is appropriate for simple health conditions. If your health concerns are more complex or chronic, please book a Full Herbal Consultation

Name

First

Last

Age

Gender

Primary Health Goal for these herbs

List one thing you wish to focus on with these herbs

Choose one type of formula are you interested in

Tea Blend
Tincture

Tea blends are loose leaf and will need to be brewed daily for medicinal results - tea blends are often less expensive to purchase. Tinctures are more expensive but are concentrated, portable, and more convenient for many people. Tinctures are in an alcohol base but the daily amount is very low.

Please list any health conditions you are currently experiencing

List any condition regardless of relation to the health goal we are formulating for

Please list any major past medical history

PARTICULARLY liver, kidney, or cardiovascular conditions including blood pressure (high or low), or clotting disorders

Have you had a surgery in the last 4 months?

Please list any allergies

Are you currently taking any medications

If Yes list medcations here (if no write n/a)

If you are on any blood thinners, SSRIs, hormone replacement therapy, or immune-modulating drugs, please list them clearly above.

List any herbs or supplements you are currently taking

Are you pregnant or breastfeeding?

Yes Pregnant
Yes Breastfeeding
No

Indicate the level of stress in your life

Selected Value: 0

1= low 10= Unbearable

Indicate the qualty of sleep you get

Selected Value: 0

1=Insomnia 10= 8+ hours of restful sleep

Indicate how consistantly you have movement in your life

Selected Value: 0

1 = Sedentary 10 = Movement is an established habit

Indicate how happy you are with your nutrition

Selected Value: 0

1=I feel under nourished by my food 10= I am getting everything I need from my nutritional intake

How warm or cold do you usually feel?

Selected Value: 1

1 = I’m always cold 2= I’m pretty neutral 3 = I run hot and am easily overheated

How do you feel in terms of moisture and digestion?

Selected Value: 1

1 = I feel heavy, bloated, or mucusy and tend to carry extra water 2= I feel balanced 3 = I feel dry, thirsty, or prone to constipation

How does your body and nervous system usually feel?

Selected Value: 1

1 = I’m tightly wound, tense, or stiff 2 = I feel fairly balanced 3 = I’m loose, tired, lathargic

Clarifying notes for the above if needed

Any questions or concerns you may have:

Include sensitivities, preferences, or anything you'd like me to know.

How did you hear about us?

Type your name to indicate understanding and acceptance of the below statement:

I understand that Cassidy Moss is a Clinical Herbalist and not a licensed medical doctor. This herbal recommendation is intended to support my health holistically based on my input and Cassidy’s clinical training in herbal medicine. This service does not include medical diagnosis or treatment. I understand: I should consult my doctor about any medical conditions or medications I’m taking. I am encouraged to share these herbal suggestions with my medical provider. A full herbal consult will provide more comprehensive care, including lifestyle and synergistic herb strategies. I am not obligated to purchase herbs through Moss Herbalism. Any adverse reaction is not the responsibility of Moss Herbalism or Cassidy Moss.