CUSTOM DESIGN QUESTIONNAIRE (Option 1)

Thank you for entrusting MalaRae with your custom designed mala, bracelet and/or wrap. Throughout the process, our intention is to create a piece that is perfect for you. By answering the questions below, your custom design will be tailored to suit your specific likes and wants.

Please be sure to read about our custom design options before proceeding to make sure this is the right one for you.

Your Name (required)

Your Email (required)

Subject

Male/Female?

Date of Birth

Mala, Bracelet, or Wrap?

If you choose a mala, would you like a tassel or gemstone at the bottom?

What gemstones would you like to use in your piece?
Crystal QuartzWhite AgateQuartz RutilePeach AventurineRose QuartzGarnetTurquoiseSodaliteAmazoniteLapis LazuliAmethystPicture JasperRed TigereyeSmokey QuartzLarvikiteHematiteOnyx

Would you like a charm added to your mala and/or bracelet?
YesNo

If yes, please specify your preferred charm:
om (silver)gita (silver)tree of life (silver)hamsa hand (gold)hamsa hand (silver)feather (silver)lotus (bronze)

How did you hear about MalaRae designs?:

COMMENTS:

PLEASE NOTE:

Most of the questions above are optional and not required if it does not apply to you or you choose not to answer. However, the more information you provide, the better suited we are to create the piece you are envisioning. The information collected will be used solely for your custom design. MalaRae keeps all records confidential.

Information provided by MalaRae is no substitute for consulting a health care professional. All material, including information relating to medical and health conditions, products and treatments, is for informational purposes only. Please see your doctor or health care professional before starting any alternative treatments, diets, supplements or exercise programs.

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