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* 1. Please type your first name here:

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* 2. Enter the email address where you would like essential oil recommendations sent here:

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* 3. What would you list or describe as the top 3 health challenges in you/your household or if all is well, feel free to describe your top 3 health and wellness goals for you/your household? (i.e., stress, overwhelm, asthma, insomnia, weight loss, fear, worry...etc.) For those focusing on household, list family member and challenge, i.e. Frequent Colds - Daughter, Managing Stress - Me, Insomnia-Mom.

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* 4. What have you been trying to help with these challenges and/or goals? How has it been working for you?

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* 5. On a scale from 0 (you need lots of help!) - 10 (you are perfect with this!) how would you rate yourself with "EATING RIGHT?"

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* 6. On a scale from 0 (you need lots of help!) - 10 (you are perfect with this!) how would you rate yourself with "EXERCISING?"

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* 7. On a scale from 0 (you need lots of help!) - 10 (you are perfect with this!) how would you rate yourself with "REDUCING TOXINS?" (Chemicals in skin care products, cleaning products, toxic environment)

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* 8. On a scale from 0 (you need lots of help!) - 10 (you are perfect with this!) how would you rate yourself with "OVERALL EMOTIONAL/MENTAL HEALTH?" (i.e. fear, worry, grief, sadness or manic behavior, anger, etc.)

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