Name *
Name
Phone *
Phone
Address
Address
Mailing? *
Is this address the best for protocol to be mailed if in person drop off is not possible? If NO, please add MAILING address in comments at bottom of form.
Which Areas of Health and Wellness do you struggle with and could use improvement in your life? *
Help to support:
In addition to the address above, are there any locations such as work that would be convenient for drop off and review of protocol?
Have you used essential oils before? *
Do you have a wholesale membership account with dōTERRA? *
In the past month, how often have you experienced negative issues related to stress or emotions? *
How would you rate your stress? *
How often do you feel emotionally overwhelmed? *
How often are you mentally exhausted at the end of the day? *
How often do you feel scatterbrained? *
How often do you feel anxious? *
How often do you have trouble sleeping? *
How often do you feel prolonged sadness or lethargy? *
How often do you take prescription or over-the-counter medication for stress, sleep, or emotional health? *
After using prescription or over-the-counter medication, how often do you feel common side effects such as stomach pain, loss of appetite, drowsiness, or nausea? *
Do your emotional health or stress levels prevent you from participating in any normal activities? *
Are you committed to participating in this study for 14 days and sharing your results via a final survey? *