Health History Form with Your Aromatherapy Fragrance Preferences


Please fill out this form which will help me understand your health issues and assist in selecting essential oils appropriate for your situation. Your submission of this form indicates you have read and understood:

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  • When did you first use essential oils? Occasionally? Regularly?
  • Health History

  • If EPILEPSY is a problem, suffer with DIZZINESS or MENTAL ILLNESS, let us know.
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1 thought on “Health History Form with Your Aromatherapy Fragrance Preferences”

  1. I thought I might outline in short the boil situation and history to give you an idea:

    The first back of neck boil emerged in spring 19. I could feel the ‘bump’ in March and it burst in April. I had no idea how to treat it properly – simply got a bunch of pharmacutical supplies to clean it and dress it morning and evening after my shower. I often left it to ‘breath’ in my ignorance. I was shocked at how long it took for the infection to clear and for my skin to heal – a month.

    It re-emerged in May last year – same spot. This time I was set on treating it properly and read that it’s better to keep it moist and covered. Same regimen – cleaning and dressing twice a day with alcohol and medical creams. Again took a month to clear and heal. This time I also dripped some tea tree on it when taking a shower.

    I did notice that there was a tiny redder ‘scar’ left after it closed so my guess is that the inection did not completely clear. I rubbed tea-tree on the skin for a while after, just in case and then occasionally lavender. But – in October noticed the bump is growing again. It’s when I got in touch with you first time. I am guessing that my skin is very slow to heal and meanwhile there is more chance for the infection to sprout again.

    This time my goal is to treat it as best I can with more oils and less medical creams, and to take more precautions for it to not re-emerge. I do not wish to involve doctors, nor to take any antibiotic.

    Thank you Cynthe.


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Cynthe Brush

Certified Clinical (Medical) Aromatherapist Creating Custom Blends Since 1999

Therapeutic Essential Oils Practitioner & Self-Care Health Educator has used essential oils for personal, family, & client health issues since 1999.

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Pre-paid on an hourly basis

Gaia’s Pharmacopeia – Buy Healing Essential Oils Blends / 100% Natural Botanical Perfumes: Effective essential oil blends for Athletic Injuries; Sprains – Broken Bones; Wounds & Surgeries; Backaches; Headaches; Dizziness; Herpes Simplex; Stress and more.