What is your first & last name? *

who makes up your family? single/married, kids/no kids, fur babes, etc *

What is your age? *

My sleep is satisfying and I awake feeling rested. *

I live my life free of physical aches & pains *

I have a strong immune system and I rarely get sick with a cold, stomach bug or flu *

I would describe myself as emotionally balanced *

I am stressed *

I am anxious or consumed by anxiety *

I have energy throughout most of the day *

I move my body enough to elevate my heart rate & break a sweat *

My mental focus and memory are quick and sharp *

My hair skin & nails are healthy and vibrant *

What are your primary health concerns? *check all that apply* *

I take over the counter medications (OTC's) *

I take prescription medications *

what type of prescription medications do you take?

What lifestyle changes do you feel would support you in achieving your healthiest, most vibrant, best-version-of-yourself goals? *check all that apply* *

Did you know that the big brands who make soaps, lotions, potions, skin/body care, oral-care, hair-care, household cleaners, etc ALL contain toxic chemicals & perfumes that are very harmful to the body? *

Have you ever used essential oils before? *

Do you already have a dōTERRA membership? *

Are there any topics from below that you are interested in learning more about? *check all that apply* *

Is there anything else you'd like me to know about your health priorities or goals? *