Aroma Freedom Therapy Individual Session Intake Form. Name * First Name Last Name Email * Phone * (###) ### #### Can you please explain in detail up to your comfort level what is the issue or specific topic that you feel you are overwhelmed, procrastinating or just can’t get off your mind. It could be a current situation, a past situation regardless of how long ago it occurred, if you are still struggling with living your best life, please share here: * Please share what outcome you are seeking to gain from an AFT individual session &/ or your goal so you can live your best days everyday? * Do you have any fears, frustrations or anxious thoughts when you think of the situation or situations holding you back from your best life? Please briefly share/explain: * Do you have any physical pain/accidents anywhere in your body currently or in the past? If so please list/explain: * Do you currently use essential oils? Do you use Young Living Essential Oils? * Please read and check the boxes below. * A. The Aroma Freedom Technique was created, researched and designed specifically to use Young Living Essential Oils only. The science and research around the quality of the essential oils and with the technique being used directly with your brain to assist in removing unwanted past emotional components that are stored directly in the limbic system, Young Living Essential Oils are only to be used and recommended with this technique according to Dr. Benjamin Perkus who created this technique. You agree to only use the suggested Young Living essential oils in the affirmations and full AFT technique during and at home after the AFT sessions to ensure the quality and the outcome of AFT is achieved. B. You will not hold Jamie Schwegel, AFT Practitioner and Angelique Enterprises, Inc liable for any health or medical conditions and agree this does not replace any mental health or medical advice or treatment of any condition. AFT is designed as a tool to assist and empower the individual to move past any negative or limited beliefs. C. You are choosing to work with Jamie Schwegel, AFT Practitioner and Angelique Enterprises, Inc on my own free will. D. You will not hold Jamie Schwegel, AFT Practitioner and Angelique Enterprises, Inc liable for any adverse or any reactions to essential oils. Slight headaches or reactions can be a result of slight detoxing of the body from past products with petrochemicals in the ingredient list. Drinking plenty of water is suggested before and after any AFT session. E. You agree and understand that an AFT individual session is $130.00 USD and is paid either prior to the session. You can pay during the booking process. By signing below you agree you have filled out the intake form to the best ability and agree to Sections A, B, C, D & E above that you have read, printed your name and agree with the above guidelines and understand any AFT individual session is at the clients risk and free will. Online form signature agreeing to statements A, B, C, D & E * First Name Last Name Date * MM DD YYYY Thank you for submitting the AFT Session Intake Form. I look forward to our session.