The Nurturing Place: Personal Blend Form

Body Bliss Skin Care

Answer the following questions about yourself, and we’ll create a massage oil or after-shower moisturizer to meet your unique needs.

If you have previously completed a Blending Profile, please click here to reorder.

Name
E-mail

For each category, check the one choice that most closely approximates your individual characteristics.

Body frame	Broad shoulders/hips Medium frame Narrow shoulders/hips
Weight	Heavy Not too thin or stout Slender
Endurance/Strength	Good Moderate Minimal
Skin texture	Pale, oily, white, moist Soft, oily, fair, pink, delicate Dry, rough, cool, darker complexion
Skin aging	Smooth, few wrinkles Freckles, moles, pigmentation Dry, flaky, cracked
Hair lubrication	Oily Medium Dry
Digestion/Hunger	Moderate, no excessive hunger Sharp hunger Irregular or heavy diet, but still thin
Elimination	Heavy, slow Moderate Tends toward constipation
Sex drive	Cyclical, infrequent Moderate Frequent
Physical activity	Avoids exercise, lethargic Likes regular exercise Restless, active
Mental activity	Calm, steady Intelligent, aggressive Restless, active
Food preference	Dry, low fat, light, sweet, pungent Sweet, medium, light, warm, bitter Sweet, oily, soupy, heavy, salty
Sleep	Easy, deep Medium, sound Short, insomnia
Reaction to stress	Indifference, complacency, withdrawal Anger, jealousy Fear, anxiety
Dreams	Water, river, ocean, lake, erotic Struggle, fire, anger, violence, war Fear, flying, running, jumping
Disposition	Stable/logical Judging/artistic Questioning/analytical

Indicate which group of words best describes you. Don’t let yourself get stumped on one word--just choose the group of words that is the most accurate.

	Flirtatious, romantic, seductive, caring, vulnerable, sensitive, concerned with appearance, image and status conscious, pretentious, competitive, conceited, friendly, successful, exhibitionist, self-promoting, self important, calculating, unrealistic dreamer
	Compliant, dutiful, conventional, organizer, respectful, submissive, jovial, willing to please, supportive, assertive, self-confident, realistic, loving, artistic, emotionally-secure, endearing, responsive, committed, rebellious, dislike authority
	Friendly, congenial, sympathetic, neighborly, welcoming, well-intentioned, emotional, demonstrative, motherly/fatherly, self-sacrificing, complacent, enthusiastic, smothering, gushing, nosy down-to-earth
	Intellectual, thoughtful, logical, solitary, introspective, idealistic, imaginative, extremist, revolutionary, detached, complicated, non-conformist, invigorating, refreshing, stimulating, vulnerable, melancholic
	Perfectionist, efficient, orderly, strong-willed, knowledgeable, balanced, persistent, persuasive, campaigner, workaholic, self-controlled, high-minded, utopian, precise, difficult, responsible, emotionally withdrawn, religious fanatic
	Easygoing, passive, good listener, down-to-earth, dedicated, try to please, put others first, originality, dislike change, modest, pacifier, controlled, conventional, traditionalist, environmentalist, satisfied
	Imaginative, creative, artistic, self-assured, introverted, expressive, caring, giving, spiritual overly sensitive, deeply feeling, fragile, misunderstood, uncertain, insightful, intuitive, self-sacrificing, amiable, tolerant, even-tempered, self-indulgent, dreamer, harmonized
	Extroverted, entrepreneurial, connoisseur, materialistic, sophisticated, exhibitionist, pleasure-seeker, entertaining, achiever, dynamic, sensationalist, passionate, emotional, power seeking, status seeking, perfectionist, attentive, controlling, arrogant, overconfident, willful
	Forceful, intellectual, individualistic, self-reliant, assertive, moral, self-confident, motivated, influential, controlling, content, perceptive, solid, unmovable, enterprising, persistent, earnest, conventional, faithful, steadfast