Aromatherapy Client Intake Form Template for Canada

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Aromatherapy Client Intake Form

I need an Aromatherapy Client Intake Form for my medical wellness clinic in Vancouver that emphasizes client medical history and medication interactions, compliant with Canadian healthcare privacy laws and suitable for clients undergoing concurrent medical treatments.

Document background

The Aromatherapy Client Intake Form is an essential document used in Canadian aromatherapy practices to establish and document the therapeutic relationship between practitioners and clients. This form is designed to comply with federal and provincial privacy laws, including PIPEDA and provincial health information legislation. It serves multiple purposes: collecting comprehensive client health information, documenting informed consent, establishing treatment parameters, and protecting both practitioner and client interests. The form is typically completed before the first treatment session and updated annually or when significant changes occur in the client's health status. It includes sections for personal information, medical history, contraindications, emergency contacts, and client consent, making it a crucial tool for safe and effective aromatherapy practice in Canada.

Suggested Sections

1. Personal Information: Client's basic details including name, contact information, date of birth, and occupation

2. Emergency Contact Information: Details of whom to contact in case of emergency

3. Medical History: Comprehensive health history including current medications, allergies, and existing medical conditions

4. Aromatherapy History: Previous experience with aromatherapy, known sensitivities to essential oils, and preferred scents

5. Current Health Status: Present health concerns, symptoms, and reasons for seeking aromatherapy treatment

6. Lifestyle Information: Sleep patterns, stress levels, exercise habits, and other lifestyle factors affecting treatment

7. Consent and Acknowledgment: Client's informed consent for treatment and acknowledgment of risks and benefits

8. Privacy Statement: Details on how personal information will be collected, used, and protected

9. Liability Waiver: Legal disclaimer and limitation of liability

Optional Sections

1. Pregnancy Status: Additional section for female clients of childbearing age regarding pregnancy or nursing status

2. Cancer History: Specific section for clients with current or past cancer diagnosis requiring modified treatment

3. Mental Health Information: Optional section for collecting mental health history if relevant to treatment

4. Payment Information: Section for billing preferences and insurance information if applicable

5. Photo Consent: Optional authorization for taking and using before/after photographs

Suggested Schedules

1. Essential Oil Sensitivity Test Results: Documentation of patch test results for specific essential oils

2. Treatment Plan: Detailed plan of recommended aromatherapy treatments and products

3. Product Information Sheet: Information about essential oils and products used in treatments

4. Home Care Instructions: Guidelines for self-care and home use of aromatherapy products

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Wellness and Spa

Alternative Medicine

Complementary Healthcare

Personal Care Services

Beauty and Wellness

Holistic Health

Relevant Teams

Legal

Compliance

Operations

Client Services

Wellness

Clinical Operations

Health and Safety

Quality Assurance

Administration

Front Desk

Relevant Roles

Aromatherapist

Wellness Practitioner

Spa Manager

Holistic Health Practitioner

Natural Health Practitioner

Clinical Director

Compliance Officer

Practice Manager

Wellness Coordinator

Alternative Medicine Practitioner

Massage Therapist

Health and Safety Manager

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Let's create your Aromatherapy Client Intake Form

Authors

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