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Zamya Aromatherepy - Online Consultation
Aromatherapy is a 'holistic' therapy, which considers the whole being (mind/body/spirit) to be of equal importance in maintaining health, and as such aromatherapists seek to look beyond the 'symptoms', taking into account a whole range of factors, such as lifestyle and emotional wellbeing etc. The more information a therapist obtains about the client, the more specific they can be in creating a synergistic blend to reflect the client's individual needs. With this is mind, Zamya has devised a simple, online consultation form to allow us to better understand your unique needs. Simply complete the form below, and Zamya will reply to you within 48 hours, giving personal recommendations of Zamya products best suiting your needs and lifestyle.

THE COST OF THIS PERSONALISED SERVICE IS EXCELLENT VALUE AT ONLY £10, AND WHAT'S MORE, WE WILL REFUND YOUR £10 IN FULL WHEN YOU PLACE YOUR FIRST ORDER WITH US, MAKING THE CONSULTATION ABSOLUTELY FREE!

Simply click HERE and pay for your consultation, then return to this page to complete the form before submitting to us. Within 48 hours you will receive your PERSONALISED ASSESSMENT/FEEDBACK by email.

NB. For residents of the UK and Europe only (coming soon to the USA).
 
YOUR DETAILS
*  Name:
*  Age Group: 25 or under 25 - 35 35 - 45 45 - 60 60+
*  Sex: Male Female  
*  Address: Telephone:
*  Email:
Would you be prepared to complete a questionnaire as part of Zamya research? Yes No
 
PREVIOUS MEDICAL DETAILS
Have you experienced in the past or are you presently suffering from any of the following? (If yes, please detail)
*  Broken Bones Yes No Details
*  Back Problems Yes No Details
*  Other Injuries Yes No Details
*  Operations Yes No Details
*  Ongoing/Chronic Problems Yes No Details
 
CURRENT MEDICAL DETAILS
*  Are you taking any medication? Yes No Details
*  Do you currently have any medical problems? Yes No Details
*  Do you have any problems that are currently being treated by a GP/ healthcare professional? Yes No Details
*  Are you currently pregnant? Yes No Months
 
MEDICAL CONDITIONS
Do you now, or have you previously, suffered from any of the following:
*  Epilepsy: Yes No  
*  High Blood Pressure: Yes No  
 
LIFESTYLE
Exercise: Every Day 2-3 x p/wk Once x p/wk Occasionally Never
Smoker (approx p/day): None Up to 10 10 - 20 20+  
Alcohol (approx units p/wk): None Up to 10 10 - 30 30+  
 
Read through the following list of general areas of health & lifestyle. Tick the boxes which best describe you at this present point in time:
Sleep (quality): Very Light Light Moderate Heavy Very Heavy
Mood (generally): Very Low Low Average Fairly Good Very Good
Skin Type: Dry/Flaky Dry Normal Combination Oily
Skin Problems: Oily Spotty Sensitive Acne Eczema
Energy Levels: Very Low Low Normal Good Excessive
Weight: Underweight Average Overweight
Mood: Balanced/Good Occasional Mood Swings Frequent Mood Swings
 
Please add any further information you consider relevant into the box below:
*   By ticking this box you are agreeing that the information given above, by you, to Zamya Ltd., is correct honest and without omission on the date that the form is submitted to Zamya Ltd. Zamya Ltd will not be held responsible for consequences arising from the misuse of its products or services. This includes both the withholding and the falsification of information given in online consultation forms. Zamya reserves the right to refuse completion of the consultation process at any point, in the event of inadequate or misleading information being supplied by the customer.
 
  
* Denotes mandatory field.
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