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PERSONAL AROMATHERAPY CONSULTATION
with Pure Therapeutic Quality Essential Oils
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Clinical Aromatherapy Consultations & Health Treatments: After obtaining a diagnosis from your physician, Aromatherapy Consultations may be done for Self-Help Education (via email or by phone) where we discuss your particular health-wellness issue(s), essential oil(s) or custom blends appropriate for self-care applications including a description of the medicinal properties of the essential oil(s) and usage suggestions.

Each essential oil has it’s own frequency and healing attributes, which may assist with physical, emotional / psychological, and spiritual issues by raising our frequencies, boosting our immune systems with the aid of powerfully healing compounds, and by bringing our being into balance through life's personal journeys.

The techniques I use for individual Aromatherapy Treatment Sessions are described in detail in my "Distance Healing" article (see link below). These sessions may be done remotely or in person at my home.

To get an idea of how I approach life, healing journeys, and working with essential oils. Please read my articles:
~ The Healing Path...A Journey of Challenge, Grace, & Inspiration and
~ Distance Healing with Therapeutic Essential Oils

If you would like to receive a consultation / treatment at my discounted aromatherapist-in-training rates, while I'm studying for my professional certification, please fill out & submit this Health History / Fragrance Preferences Form (below) before calling or emailing to set-up an appointment.

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RATES

  • $35 / up to 30 minutes treatment
  • $60 / up to an hour treatment
  • PLUS the price of your custom blend & shipping (plus sales tax - California residents). Custom blends vary in price due to individual medicinal grade essential oils & current market availability.
  • We accept payment via credit card: Discover, Mastercard, VISA at Gaia's Pharmacopeia or by personal check.
  • If you prefer to pay by check, please read our Fax-Mail-Order form PDF (Adobe Acrobat) for mailing instructions.. Mail the Order Form along with your check, which will be deposited prior to our consultation. Keep a copy for your own records.

Please Note:
All phone calls are paid by the client.

For new clients calling 707-542-0280 to schedule an appointment, I'm happy to discuss your case for 5 minutes, without charge, on the issues you'd like to work on. If you wish to discuss your case in more detail, please arrange for a pre-paid consultation appointment to be charged at my rates listed above.

For new clients e-mailing inquiries to Cynthe@EssentialOisForHealing.com, I will answer one brief question about what you'd like to work on. Then you may decide if you wish to schedule an appointment. The time and date for appointments can be arranged via email.

Appointments are scheduled Monday through Friday, between 12 noon and 5pm, PST. Booking at least one week in advance is recommended.

Cancellations require a 36-hour advance notice.

 

INSTRUCTIONS: Please fill out this Health History / Fragrance Preferences Form, which will assist me in knowing what your concerns are and the focus of our Essential Oils Consultation.

YOUR CONTACT INFORMATION

First Name   Last Name
Woman    Man   
Culture / Country of Origin
eMail
Address    Apt.
City    State / Province
 Zip / Postal Code    Country
Day Phone    Night Phone  
Have you used therapeutic essential oils before? YES     NO

If so, how long have you used essential oils?

Which EOs? Comments:

HEALTH HISTORY

Any ACUTE Health Issues? YES    
Comments:
Any CHRONIC Health Issues? YES   
Comments:
Any EMOTIONAL Stresses? YES   
Comments:
Any PHYSICAL Stresses? YES   
Comments:
Any ALLERGIES? YES 

FOODS YES
Comments:

POLLENS YES
Comments:

ANIMALS YES  
Comments:

MEDICATIONS YES
Comments:

Exposure to PETROCHEMICALS? YES
Comments:

Any SKIN sensitivites? YES
Comments:

OTHER:
ASTHMA? YES
Comments:
LUNGS / RESPIRATORY Issues? YES
Comments:
DIGESTIVE / INTESTINALIssues? YES
Comments:
ENDOCRINE / REPRODUCTIVE SYSTEM Issues? YES
Comments:
HEART / CIRCULATION problems? YES
Comments:
BLOOD PRESSURE: HIGH? YES / LOW? YES
Comments:
URINARY SYSTEM Issues? YES
Comments:
History of DISEASES? YES 
Comments:
Notable INJURIES? YES
Comments:
Notable SURGERIES? YES
Comments:
Prescription MEDICATIONS? YES
Daily SUPPLEMENTS? YES

FRAGRANCE PREFERENCES

Please indicate your LIKES / DISLIKES for each fragrance category:
~ FLORAL YES     NO   ~ CITRUS YES     NO
~ HERBACEOUS YES     NO   ~ WOODSY YES     NO  
~ EARTHY YES     NO   ~ SPICY YES     NO  
~ EXOTIC YES     NO
 

CONSULTATION SESSION GOALS

Consultation Session - CLIENT GOALS
Aromatherapy CONSULTATION / TREATMENT Personal EOs BLEND

PHYSICAL ISSUES
Aid HEALING of surgery incisions,injuries, wounds
Reduce INFLAMMATION Ease PAIN Minimize SCAR formation
Support ENDOCRINE balance / function SUPPORT KIDNEY health / function
Fatigue Insomnia

MENTAL / EMOTIONAL ISSUES
Reduce ANXIETY / STRESS Ease DEPRESSION / GRIEF
Aid FOCUS / MENTAL CLARITY PRAYERwork / MEDITATION DREAMwork
Other

MINI~MARKETING SURVEY

How did you find out about the workshops?
If OTHER, please specify details:


Please print a copy for your own records.