Tailored facial oil consultation form

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Signature Restorative Facial
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Home
About
Signature Restorative Facial
In-person Energy Healing Session
Remote healing
Aromatherapy
Tailored facial oils
Tailored body products
Contact
Published research & articles
Education
NYR Organic shop

Tailored facial oil
consultation form

Home
About
Signature Restorative Facial
In-person Energy Healing Session
Remote healing
Aromatherapy
Tailored facial oils
Tailored body products
Contact
Published research & articles
Education
NYR Organic shop

Home
About
Signature Restorative Facial
In-person Energy Healing Session
Remote healing
Aromatherapy
Tailored facial oils
Tailored body products
Contact
Published research & articles
Education
NYR Organic shop

Thank you for your interest in a personalised facial oil blend. Please complete the form below as thoroughly as possible to ensure your blend is crafted uniquely for you. If you would like to complete the online form but have any questions around this please feel message me directly, or if you would prefer to have a one-to-one consultation instead, I’d be happy to arrange this. I will contact you about payment options when I receive your form

General enquiries

Name

Date of birth

Address

What would you like to gain from your tailored oil?

What are your main skin concerns?

Brief skin history

What aromas or essential oils do you enjoy?

Are there any ingredients or aromas you dislike or prefer to avoid?

How would you like your facial oil to support you - emotionally, energetically or both

Do you have any known allergies or sensitivities

What texture or feeling would you like your oil to have?

Light Medium Rich

What texture or feeling would you like your oil to have? (1 being low, 10 being high)

1 2 3 4 5 6 7 8 9 10

How would you describe your overall state of health right now?

Have you recently experienced any of the following

Surgery Illness or infections Diagnosed health condition Chronic headaches or migraines None of the above

If any of the above apply, please provide further information

Are you currently taking any medications, or expecting to be in the near future?

Have you recently experienced any of the following

Facelift Botox Dermal Fillers Cold Sores Acne (Past or present) Boils or skin eruptions Epilepsy Pregnant or trying to conceive Eczema Burns Open skin Psoriasis None of the above apply

If any of the above apply, please provide further information

Is there any other information you feel I should be aware of when formulating your oil?

Oil size

30ml - £50 50ml - £70

How did you hear about me?

Client declaration & consent

I confirm that the information provided in this form is accurate and complete to the best of my knowledge. I understand that my personalised facial oil blend is created for cosmetic and wellbeing purposes only and is not intended to diagnose, treat, or cure any medical condition

Help me improve my skin naturally. Keep me updated with practical holistic skin care advice

Declaration date

Tailored facial oil
consultation form

General enquiries

Home

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About me

The importance of aromatherapy

Tailored facial oils

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HeartMath Certified Coach ®
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