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Aromatherapy Consultation Entry Questionnaire
Dobrý den, věnujte prosím několik minut svého času vyplnění následujícího dotazníku.
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1
Name and Surname
2
Date of Birth
Vyberte datum
3
Job Position
4
Health Condition - list allergies, chronic diseases, acute conditions etc.
5
List any medications and dietary supplements you are taking.
6
Do you do sports? (e.g. running, yoga, pilates, strength training, brisk walking, etc.)
Vyberte jednu odpověď
once a week
twice a week
three times a week or more
once in a while
no
7
Do you use aromatherapy (essential oils) in your daily life?
Vyberte jednu odpověď
yes
no
8
If you already use aromatherapy, list what essential oils you have, including the brand.
9
Is there something you currently need to address? (e.g. stress, illness, fatigue, insomnia, hormonal imbalance, etc.)
10
Do you use natural cleaners in your home? (e.g. natural soap, natural dishwashing detergent, natural washing gel, etc.)
Vyberte jednu odpověď
yes
no
11
Space for your comment, question
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