Fragrance Consent Form
Please complete this form to provide your consent regarding fragrance exposure and product use.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Fragrance Exposure or Application
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fragrance or Product Name
*
Context of Use (e.g., event, workplace, demonstration)
*
Do you have any known allergies or sensitivities to fragrances or ingredients?
*
No known allergies or sensitivities
Yes, I have allergies or sensitivities (please specify below)
Please specify any allergies, sensitivities, or restrictions (if applicable)
Please acknowledge that you have reviewed the fragrance ingredients or are aware of potential scent exposure.
*
I acknowledge and understand the potential for fragrance exposure
I do not consent to fragrance exposure
Submit Consent
Should be Empty: