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Course Sign-up Questionnaire

Goal of “Lasting Change Now – Emotional Mastery Series” is to offer you a truly personalized experience and set of tools (essential oils) assisting you in developing a level of mastery with our emotions to move through your body and experiences. Please help us customize your experience by answering the following questions.

Please rate on a scale of 1 to 10
(1=not an emotion I struggle with; 10=an emotion I struggle with a lot) and please add emotions that are important to you that may not be listed.

Anxiousness
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Fear
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Worry
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Irritability
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Frustration
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Stressed/Overwhelmed
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Vulnerable/Weak
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Self Critical/Self Doubt
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Pessimistic
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Sad
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Which are your top two emotions you would like to work on? Please feel free to explain why.

Which are your top two emotions you feel you handle really well already? Please feel free to explain why.

First Name (required)

Last Name (required)

Shipping address for your course kit:

Email

Phone