The Nurturing Place: Personal Blend Form

Body Bliss Skin Care

Personal Blend

There’s nothing like a skincare product blended especially for you. That’s why THE NURTURING PLACE is pleased to offer you a customized Personal Blend that can be used as a daily after-shower moisturizer. With your input, our unique customization process will provide you with a blend containing essential oils which will create harmony and well-being for your body, mind and spirit. As an added bonus, each time you order a Personal Blend you will receive a print-out of nurturing rituals that will further enhance your physical and spiritual accord.

Ingredients: Ingredients: Apricot Kernel Oil, Sweet Almond Oil, Jojoba Seed Oil, Vitamin E, Infusion of Calendula, Rosemary Oleoresin, Neem, Proprietary Essential Oil Blend
4 oz.

This product contains no synthetic fillers, parabens, or phthalates.

Price: $18.00

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