Aromatherapy Consultation Questionnaire

For those of you that would like to have the benefit of aromatherapy at home I offer an online consultation service. I can create bespoke blends for you based on your requirements using the information that you submit through the online consultation questionnaire below.

The blends can help relieve skin conditions like excema and dermatitis, ease muscular aches and pains, improve stress related conditions and aid relaxation. They can also be used for skin-care and home massage.

You can choose to receive your blend as a hand and body lotion, massage oil, or dispersing bath oil, or as any combination of these. Alternatively I may recommend a base such as aloe vera, moisturising cream or pure essential oils depending on the application. Each blend will consist of 30ml of the product and will arrive with instructions for application.

Prices below include postage and packing:
Consultation and 1 x 30ml personal blend - £15
Consultation and 2 x 30ml personal blends - £20
Consultation and 3 x 30ml personal blends - £25

You may also be interested in my own blends which can be purchased online after completing the online consultation questionnaire below. See the full range of pre-prepared blends. Blends cost £5 for 30ml including postage and packing.

All the information that you submit on this form is given in the strictest confidence and will never under any circumstances be shared with anyone else. Once I have made your blend I will keep this information in a secure database which only I have access to. You can choose to have it deleted once you have received your blend. It is helpful if you can give me some idea of the problem you are facing and information that might help me to determine a useful blend of oils to support you. For baby massage oil please give the age and any relevant information for the baby. You are free to give me as much or as little information as you choose and you accept the blend at your own risk. Aromatherapy is very safe if you follow the simple instructions for use which will accompany your blends.

Please fill in your details below and submit the form, you will then be able to make your purchase and pay online.

years
Please tell me about the issue you would like to address including how long you have been experiencing any symptoms, frequency, medication or other treatments you are following.
Please tell me about any current treatments you are having for this or any other issue.
Are you taking any prescribed medication? What is it for?
Please list any supplements you take eg. vitamins or minerals,
Please tick the box if you have experienced problems in this area of the body
If you ticked any boxes above please give details, for example if you ticked 'Respiratory' it could be asthma attacks or bronchitis you experience.
Please tell me about any operations you have had and any injuries you have sustained.
Do you have any specific stresses that might be affecting your condition that you would like to tell me about?
Use this box to tell me how you would like the blend to help you.
Is there anything else you would like me to know?
Please select one option
Please tell me the names of any essential oils that you particularly like.
Please tell me the names of any essential oils that you particularly dislike.
Please tick the box to continue

aromatherapy for you

Buy fresh aromatherapy blends - made to order online.
or receive your own bespoke blends with an online consultation.