Aromatherapy Release Form
Please read and sign below:
I have stated all my known conditions and have answered all questions honestly. I take it upon myself to keep the practitioner updated on my health.
I understand that the consultant does not diagnose, prevent or treat illness, disease or any other physical or mental conditions.
I understand that this treatment is not a substitute for medical treatments and/or diagnosis, and it is recommended that I see a qualified professional for any physical or mental condition that I may have.
I understand this treatment is not a substitute for medical care.
I have read the “Safety Information Page” and agree to follow of these guidelines.
I understand the following:
- I am not being advised to take any essential oil products internally
- I must keep all essential oil products out of the reach of children
- Essential oils could be poisonous if swallowed
- Essential oils must be stored in a cool, dark place
- Essential oils may irritate the skin if not stored or used properly
- Essential Oils must not be used with animals
- Essential Oils must not be used on the skin of babies or children under 1 years old
- Essential Oils must be used with extreme caution for children under 5 years old.
I hold my essential oil consultant, Carol Pedersen harmless for any injuries or negative effects I may experience as a result of using the products I receive from this consultation.
Client Signature Date
Carol Pedersen, CA, RA
Aromatherapist Signature Date