Release Form

Release Form

Please read and sign and keep for your records.

I understand that the information I have shared during the consultation will remain confidential and not be shared with anyone. My name will not be disclosed and my personal information will never be discussed.

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 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, (Name of consultant)______________________ 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