Discovery for Personal Blend Scent

Discovery for Personal Blend Scent
Date

MonthDayYear
Date
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Favorite Color
Temperament Type
Favorite kind of scent: floral, woodsy, citrus, spicy, minty
Favorite personal indulgence. Something you do more often for yourself
What is your current most prevalent emotional trigger, if any: Anger, Abandonment, Shame, Fear, Powerlessness, Tainted, Invalidation, Hopelessness, Confusion or a word of your own.
What is your current demeanor or outlook on your life? What is your vision of the best,healthy you? Please describe in detail
I have been informed that Maria Malec, Aroma-Living by Design, LLC provides this Discovery form to effectively design an optimal personal essential oil blend for personal aromatic use only. Not intended for medicinal purposes.

I understand that I will accept full responsibility for any decisions I make regarding my life, and I will not hold Maria Malec or Aroma-Living by Design, LLC or any agency she represents responsible for any legal action, tort, including invasion of privacy, outrageous conduct, intentional infliction, or emotional distress that may arise.

I understand that my personal information will note be shared with anyone.
Signature (type your name in box to confirm)

Clear
How did you find me?
With peace & blessings,

Maria Malec

Your Wellness Guide
Connect with me:

813-957-0865

aromalivingbydesign@gmail.com
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