iTERRA™ Wellness Intake — Final Rose-Gold Edition

Adult Male Adult Female Child / Teen Pet

Choose up to 3 (or select Full-body Reset).

Full-body reset

Approach

Daily maintenance / preventive care Stress reduction Life events / seasons Mood & energetic alignment Full-circle system support I want a complete, concierge solution

Experience & Use

I’m new to natural wellness tools I’ve dabbled / used a few I already have a routine I’m advanced and ready to upgrade As needed / reactive Daily preventive During stress / seasons / transitions For mood & energy For kids, pets, or family care For home / environmental detox

Select aromas and mood cues to see suggested pairings (chakra • frequency • aroma families).

Select the aromas you’re drawn to. This drives curation.

Mood cues (check any):

Focus areas

Hormonal support (PMS, peri-/menopause) Mood & cyclical shifts Radiance — skin, hair, beauty Reproductive wellness / libido Sleeping beauty (restorative sleep)

Cycle snapshot

Currently pregnant / postpartum / nursing

Cycle day (if applicable): —

Flow / intensity: —

Cycle phase Regularity

What this does: Your primary dosha guides formats, timing windows, and scent direction for precision curation.

Vata Pitta Kapha

Don’t know yours yet? Answer the mini-questionnaire below — we’ll suggest a likely match. You can still override.

Suggested Dosha: —

Sun sign

Cell salt auto-pairs from your sign.

Auto-paired cell salt

—

What this does: Weights your selections across focus chakras, food color cravings, and preferred frequencies to compute a live top-focus recommendation.

Focus chakras (pick any that resonate)

Food tendencies

Frequency preferences

Frequency sensitivity (0–10): 5

Top focus (live): —

What this does: Sets pace and safety layers for a 30/60/90-day path.

Kickstart duration

Readiness today (0–10): 5

Daily foundations

≥ 8 glasses water Protein at breakfast 7–9h sleep

Current supplement use

Multivitamin Digestive enzymes Liver support Probiotic Microbiome reset protocol

Digestive snapshot

Bowel movements/day: 1

Frequent bloating Reflux / discomfort Sensitive to new supplements

Soft / loose Ideal / formed Dry / hard

Optional inclusions

Include binder timing guidance Start gently / stepwise Include sauna, hydration, walks

Sleep (hours): 7

Daily stress (0–10): 4

Energy today (0–10): 6

Hydration Low Moderate Optimal

Digestion Sensitive Okay Robust

Preferences Include probiotic support Include EFA / omega support Include DIY recipes Include pet compatibility chart

Meals per day

1–2 3 >3

Primary diet style

Cravings (often)

Hydration specifics

Tap Filtered Mineral / spring

Glasses per day: 8

Eating window (hours): 12

Sensitivities

Goals

Stress & behavior Immune support Skin / coat / feathers Digestive / urinary Mobility / joints General vitality / healthy weight

Preferred delivery

Diffuser nearby External (diluted) Home environment only

Water bowl type

Stainless Ceramic Glass Plastic (avoid)

Diet type

Kibble Wet / canned Raw-leaning Mixed

I understand this intake is educational only and not medical or veterinary advice. I agree to safe use practices and to discontinue any tool that causes discomfort.

Please confirm both items before continuing.