1. Are you a professional aromatherapist ?

a  yes

b.  no

2. If yes, to what professional aromatherapy organisation do you belong? (If no, please go to question 3)  

3. Are you a lay-person?

a. yes

b.  no

If yes, please go on to question 6

4.If a professional therapist, estimate number of treatments given per year (if not, please go to question 6)

5. Estimate of number of treatments given per year using tea tree oil.

now please go on to question 7

6. If a lay-person, estimate number of applications of tea tree oil you have applied to yourself in the past year

7. Have you ever experienced on self or client an adverse reaction to tea tree oil?

a. yes

b. no

If "no" please tick "not applicable" boxes until you reach question 30

8. Date of reaction (if known) 

9. The reaction occurred to

a. self

b. client

c. not applicable

10. Was the environment  the treatment/application took place in relaxing?

a. yes

b. no

c. don't know

d not applicable

State rough geographical location where patient lives (e.g. Birmingham, England - please, no full addresses!)

11. Was the subject of the adverse reaction

a. relaxed before the application/treatment

b. not relaxed before the application/treatment

c. don't know

d. not applicable

any other comments

12. The reaction occurred:
a  at the site where oil was applied  

b. on a different part of the body

c. not applicable

13. Please state on what precise area(s) of the body the reaction occurred  

14. The following symptoms were present:

flare - redness

wheal

tingling      
Itching
nettle rash

headaches
nausea

none

15. The reaction occurred:

 a.immediately on application of oil

 b.within half an hour of application of oil

 c. between 1 & 24 hours later

d. not applicable

16. Did the reaction:

 a. disappear  within 1 hour

  b.disappear within 1 – 24 hours

  c. last more than 24 hoursd.

  d. not applicable

17. The tea tree oil was used:

a. on it's own

b. in a  blend

c. not applicable

percentage strength of essential oils:

If not known, state drops of essential oil in how much carrier eg. 10 drops in 20ml carrier or drops per oz. - we will work out the approx. percentage from this.

or state 'neat' if not diluted

18. If a carrier oil was used please give details  

Give details of any other essential oils used in the same application where reaction took place (Latin name if known). 

19. How long since oil was purchased ?

a. less than six months

b. more  than six months

c. not known

d. not applicable

20. If a diluted product was used was it:

a. made up by the practitioner

b. a retailed shop item

c not applicable