Full Name: Gender: Male or Female Phone:
	Cell phone: Email address:
	Preferred contact method: Current occupation: Date of birth: Place of birth: Time of birth a.m or p.m. Mailing address: Overall length of necklace (measure your favorite necklace): Would you like a focal point such as a pendant? Passionate and outgoing - fire Many emotions, intuitive - water Grounded, but can get stuck - earth Ungrounded, lots of ideas and a bit spacey - wind Intellectual - very much in your head Determined - driven, hard to relax Perfectionist - very particular Do you consider yourself to be (click on what applies to you above): Protection, strengthens energetic and psychic boundaries. Support with physical body, ease discomfort. Connection with intuitive realm, enhance your Divine Feminine. Relaxation and sleep disturbances. Other What is your main purpose for your Faedra jewelry piece?  Check all that apply above: Base: Physical Energy, Family Karma, Safety, Stability, Connection w/ Earth Sacral: Life Connection, Vitality, Pleasure, Intimacy, Creativity, Passion, Spontaneity Solar Plexus: Health, Strength, Self-Recognition, Destiny, Digestion, Immune Support Heart: Love, Relationships, Calmness, Truth, Acceptance, Values, Compassion Throat: Communication, Creativity, Gratitude, Abundance, Integrity, Worthiness, Teaching, Thyroid Brow: Sleep Cycles, Intuition, Imagination, Psychic Doorway, Memory, Third Eye Sight Crown: Mind, Knowledge, Understanding, Thought, Reaction, Coordination Please select which Chakras you would like your necklace to focus on from the list above. Please scroll over to the right for the dropdown menu. Small, delicate stones Tumbled and irregular shaped stones Medium stones Large stones Round stones Faceted stones What style of jewelry do you envision wearing? Please note that Faedra Jewelry almost always includes sterling silver beads and pieces to increase the vibratory presence of the gemstones. What else would you like me to know about you or your preferences while creating your beautiful therapeutic jewelry? Please list your comments above. Price is no object for me. The most I am able to spend at this time is $_____. Please contact me with an estimate before completion. Faedra Jewelry is priced from $125-$500 plus insured shipping and handling.  Please check one of the above.