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You are here: Home / Educate & Empower / Safety / Safety Intake Form

Safety Intake Form

As aromatherapy and the use of botanicals continue to gain acceptance within the holistic field, there is also increasing interest in incorporating aromatherapy and other natural therapies for use with our animal friends.

It is important to note that animal lovers always want what is best for their pets, and often will seek out information and advice via the internet, blogs and social media groups and for the most part the information may not include or contain safe use instructions, or applies to humans and not for actual use with animals.

Unfortunately, without education and proper instruction in the safe use of aromatherapy and botanicals for their animal friend the consumer is left to figure out how to use these ingredients on their own, or follow out-of-date or random advice. This may lead to the animal experiencing a negative reaction, yet the reaction is usually due to issues such as not diluting properly or accidental ingestion of large amounts), rather than when used safely with common sense use and with high-quality tested ingredients (vs artificial fragrances, oxidized or rancid oils, or cheap knock-off products, etc.)

If your animal friend has experienced a negative reaction due to exposure to essential oils or botanicals, please feel free to fill out and submit your information via the online Safety Intake Form below. Please submit one form per each individual animal. 

Animal Aromatherapy Safety Intake Form

This form is for individuals that would like to submit details pertaining to a negative reaction that their animal friend may have experienced due to exposure or use of essential oils and or aromatherapy ingredients. The form must be filled out by the animal’s caregiver (owner) and include answers to all questions.

Submitted information will also serve as an educational tool to help others learn more about the safe use of aromatherapy with their animal friends. The information submitted will be compiled and shared with others (via published on blog, e-booklet, social media, website, etc.)

In order to submit a safety intake form the animal’s caregiver (owner) must answer all of the below questions (if a question does not apply, type in ‘does not apply’). We do not accept or process incomplete forms.

We encourage the submission of photos (if applicable), such as with a skin reaction. Photos must be properly labeled (Your Full Name, Animal’s Name and Date Taken).

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  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Animal's Information

  • Please enter the age in years and/or months.
  • General Health Questions

  • Essential Oil Questions

    If you think the reaction may have been due to an essential oil or aromatherapy product please answer the following questions and be sure to include as much detail as possible.
  • List any and all essential oils (including both the common name and the botanical name i.e. Lavender (Lavandula angustifolia) if this information is provided on the product label).

    Please also list aromatherapy company (list name), health food store, non-aromatherapy business (chain store, etc.), batch number, aromatherapist or other practitioner.
  • By submitting this online safety intake form you are acknowledging that all the information submitted is true and that you give permission for the information and details (including photos) to be compiled and shared with others and in other formats such as (published within a report, website, blog, social media, etc.).

    You agree that this online form is not being submitted as a substitute or replacement for veterinarian medical care or emergency care for your animal. We have the right to reject any form submitted that is not complete or trustworthy. This online form option may be discontinued without any notice.

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Disclaimer: The information contained in the educational programs and course materials are not intended to diagnose or take the place of professional health care. Always consult with a veterinarian physician in regards to any serious health concerns and issues. The information contained in this handout is for personal awareness only, it is not meant to diagnose or treat any serious health problems/conditions.

Ashi Therapy Ashi Aromatics Inc. © Copyright: Ashi Therapy Ashi Aromatics Inc. All rights reserved.

No part of this document or information may be copied, transmitted, shared or sold.

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