I completely understand how the science of aromatherapy works for my body. It is only a supporting holistic treatment that is not to intended treat or diagnoses any medical conditions and illnesses. I attest that all personal, medical information listed above is true and accurate, in the event that I am required to provide a medical certificate, I shall comply with submission. All information listed on this form is strictly confidential and privacy shall be maintained at all times. The practitioner can use my information for a case study, generation treatment plans, and my personal copy should be given to me 2 to 3 days prior to my first day of treatment. I should appreciate and respect the practitioner's recommendation of therapeutic treatments with their choice of highest grade essential oils and essence.