Questionnaire for the creation of
Your Personal Designer Fragrance
Aromatic blends to enhance energy and uplift the senses.  
Formulated on an individual basis . . .
If this is a gift, this questionnaire can be completed by a loved one or close friend.  If there is
something of which you're uncertain, guess as closely as possible but mark the answer with an (
*)
so our Perfumer is aware of the potential variance.
Name:
D O B:
*
*
*
P O #:
1.  Briefly describe a perfect day:  (Location/activity)
Ex:  beach/swimming & sunning; mall/shopping; woods/camping & hiking; family picnic/games; alone/reading or hobbies
2.    List your favorite food, beverage, and dessert
3.  List your most displeasing food, beverage, and dessert
4.  Career or Profession:
5.  On a scale of 1 to 10, how well do you like your choice regarding your Career or
Profession?                      1 being "very dissatisfied" and 10 being, "I love my job!"
6.  Do you consider your present employment and lifestyle activities to be your life's purpose?  
YES
NO
If the answer is NO, what do you believe is your life's purpose?
7.  Hobbies and Interests
8.  Time distribution between work, responsibilities, leisure, and rest, in an average day.   
9.  Emotional outlook
10.  Sleep pattern
11. What part of the day do you prefer?
12.  Choose one of the six
13.  Are you a worrier?
YES
NO
14.  What is your comfort food?

When ill?

When sad?
15.  Amount of time spent contemplating the following five . . . Please answer all five
in                              percentage relationship to each other.  For example:  A. 15%, B. 30%, C. 10%, D.
15%, E. 30%
A.  the Past

B.  the Future

C.  What ifs . . .
D.  Regrets

E.  Goals
%
%
%
%
%
16.  Briefly describe what circumstances or situations cause you to experience these
negative        emotions.  May be personal or societal . . .
Sadness
Anger
Grief
17.   How would you rate your contentment in life, on a scale of 1 to 10?  
1 being very dissatisfied, 10 being quite satisfied.
18.  When and where are you most contented and at peace?
Please feel free to list additional information or comments that you feel to be pertinent
to the formulation of your personal designer fragrance
Formulation of Personal Designer Frangrance will be completed in 10-14 days