Poetry Request

🌿 Custom Poetry Intake Form 🌿

Thank you for choosing J. Claire Poetry to create a custom piece just for you. Please fill out the form below so I can craft a poem that reflects your story, emotions, and vision.



Contact Information



Purpose of the Poem



Style & Tone



Details to Include



Length Preference



Delivery Format



Timeline



Additional Notes



Budget & Payment

My custom poem packages start at $125, with add-ons available. Please share your budget range if you’d like me to recommend the best option.
✨Once submitted, I’ll review your request and follow up with confirmation, pricing, and next steps. Thank you for trusting me with your story.

Prefer to fill it out offline?

If you’d rather complete the form at your own pace, you can download it instead.
Once filled in, simply email it back to me at Jclairepoetry@gmail.com.

Download Intake Form