Discovery for Personal Blend Scent

Date

Name

First Name Last Name

Email

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Event Name, if applicable

Date of event attending

Favorite Color

Personality or Temperament Type (i.e., Dani Johnson Gems)

Discover your temperament/personality here

Favorite kind of scent: floral, woodsy, citrus, spicy, minty

Favorite personal indulgence. Something you did more often for yourself

What is your current most prevalent emotional trigger, if any: Anger, Abandonment, Shame, Fear, Powerlessness, Tainted, Invalidation, Hopelessness, Confusion or a word of your own.

What is your current demeanor or outlook on your life? What is your vision of the best,healthy you? Please describe in detail

If you would like to connect on a deeper level join me for

Destination Rejuvenation

Spend a weekend or more with me in my home to get pampered and rejuvenated while obtaining hands on Informed Self-Care guidance. Includes a private room and shared bathroom. 3 Healthy meals+snacks per day, fresh made juices, light fitness, kitchen-food prep andcooking instruction, grocery store tour, essential oil and daily inspirationaltraining, 1 field trip, alone time.

Optional adds on: Raindrop massage, yoga instruction, heart & mind harmonizing technique. Weekend and week options available.

Would you like me to contact you with further details and pricing or to book your experience?

I have been informed that Maria Malec, Aroma-Living by Design, LLC provides a Discovery form to effectively design an optimal personal essential oil blend for personal aromatic use only. Not intended for medicinal purposes.

I understand that I will accept full responsibility for any decisions I make regarding my life, and I will not hold Maria Malec or Aroma-Living by Design, LLC or any agency she represents responsible for any legal action, tort, including invasion of privacy, outrageous conduct, intentional infliction, or emotional distress that may arise.

I understand that my personal information will note be shared with anyone.

Signature (type your name in box to confirm)

Clear

How did you find me?

Thank you for your purchase,

With peace & blessings,

Maria Malec

Your Wellness Guide

Connect with me:

Schedule a BREAKTHROUGH CALL

813-957-0865

www.aromalivingbydesign.com

aromalivingbydesign@gmail.com