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AROMATHERAPY TREATMENT RECORD   (CONFIDENTIAL)          
Date …………...………….


NAME…………………………………………………………………    DOB……………………………............................
ADDRESS……………………………………………………………………………………………………..........................
GP  ………………………………………………...................         
KEYWORKER……………………………………………........
CONSULTANT  ……………………………………………….
PERSONAL HISTORY





MEDICAL HISTORY/GENERAL HEALTH
(Include disabilities, respiratory, digestive, circulation, epilepsy, allergies, diabetes)





CURRENT MEDICATION 

ANY CURRENT TREATMENT 

EMOTIONAL/MENTAL HEALTH

BEHAVIOUR

COMMUNICATION

SLEEP

EATING

ACTIVE OR PASSIVE

INTERESTS/LIKES/DISLIKES

OTHER RELEVANT INFORMATION



TREATMENT AIMS



TREATMENT PLAN





OILS TO BE USED (state number of drops):

CARRIER USED (state mls):

METHOD OF APPLICATION:

CAUTIONS:


I confirm that the above person is agreeable to receive Aromatherapy treatments


Signature …………………………………………………………………..


Position ……………………………………………………………………..                                      Date ……………………..

© Aromacaring 2000

Keeping records

 

© Jane Ellwood
Please seek permission if you intend copying the information on this website in any way unless it is for your own personal use.
The Aromacaring website is maintained by Jane Ellwood Dip(HE) RNLD, MIFPA, AC Registered Aromatherapist.
 Information on these pages is for educational purposes only and you are recommended to contact your GP before using any form of therapy for an existing medical condition. Aromacaring is unable to offer treatment or diagnosis via email.