Aromatherapy Intake & Preference Form
Share your aroma preferences, sensitivities, and how you’d like aromatherapy used before your appointment.
Which aromatherapy blend would you like for your session?
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Pain — Comfort & Recovery
Grief — Comfort & Grounding
Morning — Awaken & Refresh
Evening — Rest & Unwind
Therapist Recommendation
Aromatherapy Blend Descriptions:
- Pain — Comfort & Recovery: Soothing, supportive oils for muscle and joint comfort.
- Grief — Comfort & Grounding: Gentle, grounding aromas to support emotional well-being.
- Morning — Awaken & Refresh: Uplifting, energizing scents to start your day.
- Evening — Rest & Unwind: Calming, restful blends to promote relaxation.
- Therapist Recommendation: Let your therapist select the blend best suited to your needs.
Which aromas do you prefer? (Select all that apply)
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Citrus / Fresh
Floral
Herbal
Minty / Cooling
Woody / Earthy
Warm / Spiced
Soft / Calming
I’m not sure — please choose for me.
Are there any scents or essential oils you strongly dislike?
Do you have any sensitivity or allergy to essential oils or fragrances?
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No
Yes — Please explain
Have you ever had a reaction to an essential oil, fragrance, perfume, or scented skin product?
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No
Yes — Please explain
Do you currently have any of the following? (Select all that apply)
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Asthma or respiratory sensitivity
Migraine or headache triggered by fragrance
Sensitive skin
Eczema, dermatitis or another active skin condition
Known allergies
Pregnancy or breastfeeding
None of the above
If you selected any of the above, please provide additional information (optional):
Are you currently using any prescription or topical medications on the areas being massaged?
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No
Yes — Please explain
How would you like aromatherapy to be used in your session?
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Aromatically only
Incorporated topically into my massage when appropriate
I am comfortable with either
I would like to discuss this with my therapist first
How strong would you like the aroma to be?
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Light — Very subtle
Moderate — Noticeable but not overpowering
Immersive — A more prominent part of the massage experience
Client Name
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First Name
Last Name
Signature
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Date
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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