CLIENT RELEASE FORM for USE OF ESSENTIAL OILS IN

RAINDROP TECHNIQUE ™SESSION

Please print Information: Date ____________________

Name________________________________________________________Mailing Address_______________________________________________
City_________________________________ State_________Zip________

Home Phone__________________________Cell Phone_______________
DO NOT PUT ON PERSONAL CARE PRODUCTS THE DAY OF THE SESSION, especially any body creams. Therapeutic grade essential oils can react with chemicals and other additives common in products. Be aware, even if a product is labeled organic it may still have additives.

I, the undersigned, acknowledges that aromatherapy covers a wide variety of areas and that Susan H. Paige, OMC, LMT, MTI, is not a medical doctor or medical advisor, nor does she have a license in aromatherapy.

By signing this release I acknowledge that is it my own sole responsibility to get medical advice from my doctor concerning any medical concerns I have.

I hereby release Susan H. Paige, OMC, LMT, MTI, in her capacity individually and as president of SHP Transformation, Inc., from any claims and damages, which may result from my neglect to consult a physician of my choice as to use of essentials on my body, that I have concerns about.

_____ I have listened to D. Gary Young, N.D. tape “ The Missing Link”

_____ I have not listened to D. Gary Young, N.D. tape “The Missing Link”

I understand that this Raindrop Technique™ is a proprietary technique using therapeutic grade essential oils produced from Young Living Essential Oil Company. The applications of these oils to my body may bring balance and harmony to my body. The following oils will be applied to my body:

1. Valor, a proprietary blend formulated by Young Living Essential Oils Company, oils included are spruce, rosewood, blue tansy, and frankincense in a base of almond oil, may help promote balanced energies in the body, and may encourage feelings of self esteem, dilution not required*

2. Thyme, antioxidant, considered a hot oil, which can burn the skin, always dilute*

3. Oregano, an antioxidant, is considered a hot oil, which can burn the skin, always dilute*

4. Basil, may relax muscles, dilution recommended*

5. Wintergreen, soothing for massage.

6. Cypress, may support circulatory system *

7. Marjoram, may assist in calming nerves, dilution recommended*

8. Aroma Siez™, a proprietary blend formulated by Young Living Essential Oil Company, oils included are basil, marjoram, lavender, peppermint and cypress. May help relax tight muscles. Dilution recommended*

9. Peppermint, may support normal digestion, dilution recommended*

10. Ortho Ease, Massage Oil, a proprietary blend formulated by Young Living Essential oil Company, oils included are wheatgerm, grape seed, almond, olive, Vitamin E, and essential oils of wintergreen, juniper, marjoram, red thyme, vetiver, peppermint and lemongrass, may soothe muscle discomfort*

Essential oils have the effect of carrying oxygen into the cells of the body, which may cause a detoxification affect on the body. If your body does experience a detoxing, which may cause headache or nausea, it is a positive reaction as it means that you are releasing toxins from your body. We are constantly exposed to toxins in our food and environments, which our bodies absorb. Having oxygen carried to our cells is one way to help detoxify. This may be a new experience and it is necessary to drink more water than usual for several days following application. A suggested amount would be at least double your usual intake of water. Once the detoxification is complete you may feel lightheaded or increased energy.

I have read this release and understand am aware of the application of essential oils to my body and the manner in which it may affect my body.

I further agree that I will consult my health care professional, Doctor, etc. If I have any concerns with this application of essential oils to my body.

*If I am taking any medication, herbs or other forms of health treatment, prescribed by my Doctor, or I am under a doctor’s care for any reason, I will discuss with the massage therapist. If necessary I will provide a release from Doctor to Susan Paige before having these oils applied to my body. If you are pregnant or menstruating, you cannot receive these oils.

_______________________________________________ __________

Client Signature Date

_______________________________________________________ ____________

Susan H. Paige, OMC, LMT, MTI, President (massage license # MT031134) Date

* Information obtained from: Scents & Scentsability, Young Living Essential Oils;

and An Introduction to Young Living Essential Oils, D. Gary Young, N.D.

Young Living Essential Oils, 3125 West Executive Parkway, Lehi, Utah 84043