Guest Card

Please email your answers to the questions below to blendsaroma@mail.com  

Name

Email

Gender

Age

Allergies

Medication (what they are for)

Any health concerns

Smells you like

Smells you dislike

The therapeutic cross reference guides used to create the custom blend suggestions cover areas such as: Mind, Skin, Body, Hair, Chakras. 

List 1-3 concerns on how are you feeling today? 

Example: headache, aches and pains, tiredness

Example: dry skin, wrinkles, worry

Please let me know if you have any of the following as some essential oils are contraindicated:

Alcohol (contraindicated for some oils)

Anemia

Appetite loss

Asthma

Blood pressure: low or high

Blood clotting problems

Breast feeding

Cancer: Where?

Cardiac fibrillation

Convulsions

Concentration needed

Cyst (estrogen dependent)

Depression (severe)

Diabetes

Dizziness

Heavy period

Endometriosis

Epilepsy

Fibrosis (uterine/breast)

Glaucoma

Hemophilia

Headache

Homeopathic Remedies

Insomnia

Kidney/bladder infection

Kidney disease

Menstruation (painful)

Palpitations

Paralysis: Where?

Peptic ulcers

Pregnancy

Suntanning

Prostate problems

Seizures

Sensitive skin

Sleeping problems

Surgery (Major): When?

Thyroid imbalance

Uterine spasms

Wakefulness

Whooping cough

What will the suggested custom blend be used for? 

Diffuser (inhalation)

Massage oil or cream

Body or Face cream

Bath

Body exfoliate scrubs.

Thank you for taking the time to view the guest card. 

Disclaimer

The personalized essential oil custom note blend suggestion not said to cure diseases or to replace medical care or medications. Always seek medical advice about your health, medication and treatments recommended by your doctor or medical specialist before using essential oils. 

Do not ingest essential oils!!!  I know that some countries do this but for the purpose of the custom blending suggestions, ingestion is not recommended. 

Do not put essential oils directly on the skin without a carrier as reactions may occur.

Please note the following:

• The custom blend suggestion will be for 1 treatment only. This way you will be using your custom blend safely and able to monitor the amount of essential oil drops used in a 24 hour period.
• The personalized custom note blend suggestion will Not cover areas such a childbirth, please seek a medical professional prior to using essential oils.

The information given in the essential oil custom blend suggestion will not be held liable for misuse of any essential oils or misuse of the essential oil custom blend suggestion.