Personalized Aromatherapy Client Information Form

Payment Procedure
Upon submitting this form, you (client) will be redirected to a checkout webpage for paying a processing fee of $5. This fee must be paid using a debit card or credit card prior to My Wealth in Health reviewing this form. You will receive 2 separate emails upon form submission: one to confirm the form has been submitted and another with a receipt for the processing fee payment. Please allow at least 2 business days for this form to be processed and reviewed after payment.

After this form has been reviewed, you will receive a quote via email for the customized aromatherapy products. Upon your email reply confirming the quote is acceptable, you will be sent via email an invoice with the quoted price and shipping cost (if applicable) minus the $5 processing fee. All payments must be made using a debit card or credit card upon receipt of the invoice prior to the products being made and shipped.

Warranties and Returns
Personalized essential oil products cannot be returned or exchanged. My Wealth in Health is not responsible for items lost in transit, nor is My Wealth in Health responsible for replacing items that have been modified or subjected to neglect or damage due to accident, fire, water, or improper use or application.

Confidentiality
My Wealth in Health recognizes that you (client) are providing personal and proprietary information within this form. Your information will not at any time, either directly or indirectly, be used for personal benefit or disclosed or communicated in any manner to any third party without your written permission or that of a parent or guardian if you are under 18 years of age. My Wealth in Health will hold everything that is said and done regarding your aromatherapy request confidential unless you present a physical danger to yourself or others. In this case, My Wealth in Health will inform legal authorities so that protective measures can be taken. In addition, you should know that unlike a physician or a lawyer, our confidentiality agreement is not protected by law. Should it ever happen, My Wealth in Health cannot claim in court to be unable to divulge the contents of our conversations.

Client Waiver
Simply stated, My Wealth in Health cannot be held liable for any resources or education that is provided. You (client) have stated all your known conditions and have answered all questions honestly. You take it upon yourself to keep My Wealth in Health updated on your health. My Wealth in Health also cannot be held liable for any injuries or negative effects you may experience as a result of using the products you receive from this consultation. You understand the following:

• You are not being advised to take any essential oil products internally.
• You are advised to consult a licensed physician about each and every essential oil product before use.
• You must keep all essential oil products out of the reach of children.
• Essential oils products could be poisonous if swallowed.
• Essential oils products must be stored in a cool, dark place.
• Essential oils products may irritate the skin if not stored or used properly.
• Essential oils products must not be used with animals.
• Essential oils products must not be used on the skin of babies or children under 1 year old.
• Essential oils products must be used with extreme caution for children under 6 years old.

By signing this form, I (client) confirm I have read this form, and my questions have been answered. I understand that aromatherapy is an alternative therapy that uses essential oils to promote physical, mental, and emotional well-being. I understand that aromatherapists do not diagnose conditions, do not prescribe or perform medical treatment, do not prescribe substances, and do not interfere with the treatment of a licensed medical professional. I understand that aromatherapy does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have.