First Name *

Last Name *

Email *

Phone *

Recent Experience - How often have you struggled with your issue in the past week?

Almost Never

Sometimes

Almost Always

Always

In the past week, how severe were your issues if/when it occurred?

(Linear Scale: 1 to 10)

What type(s) of issues do you experience? *

For example: falling asleep, headache, bloating, stress, hay fever, etc.,

How long has this been a problem?

Less than 1 Year

1 - 3 Years

3 - 7 Years

7+ Years

What would it mean to you to find a solution to this problem and how would it impact your life?

If you are on medication, please confirm you are happy to participate and will consult a medical professional prior to the trial if you feel necessary to do so.

Yes, I am on medication and understand the statement above

N/A as I am not on medication

If you have allergies, please confirm you are happy to use the products for the trial you have chosen

Yes, I have allergies and I am happy to use the products

No, I do not have allergies

Taking part in this trial means you are under no obligation; however, if at any point you would like to purchase doTERRA oils or products, please reach out to the person who invited you to take part in the trial. (Please do not purchase them online as you will not receive the support from the WA who introduced you to this trial as you will be linked to someone else). You will be given an opportunity to purchase them at the end of the trial should you wish to.

I understand

Do you have any questions?

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.