Crazy-Mamas - Perfume QUESTIONAIRE - Spring, TX
Dance of the Divine Dragonfly - Pheromone Perfume Potions & Power Jewelry
 
pheromone fragrances for women and men 
Questionaire
For Your Personal Pheromone Perfume
 

Is necessary to produce a Personalized Pheromone Perfume Potion for you. After completion, make a copy to bring with you to your appointment. 
 
Please read the Disclaimer below.
No spam & no sharing of your information guaranteed.
Respectfully Yours, Diana Diamond
 
Any Questions??? Email Diana at:  dianadiamonds8@gmail.com

IMPORTANT
 If you are coming to create your Personal Pheromone Perfume @ Crazy Mama's:
Don't wash your hair the morning of your appointment.
 Don't wear any perfume, cologne or
scented products from the neck up.
This will enable Diana Diamond to ascertain your 
Personal Scent Fingerprint.


 These scents are unlike any commercially prepared colognes, perfumes etc.  No chemicals or preservative additives for long shelf life.  Only the purest true scents are used in the preparation of your Personal Pheromone Perfume Potion. 
 
They are intended to be worn daily to not only attract & manifest your desires and intentions- But also to change your perceptions & approach problem solving in completely different ways that ensure success. 
 
In order for you to project confidence, poise, beauty, & authority in an inviting and magnetic manner, you must feel relaxed and at ease.  Using aromatherapy on yourself to become unblocked and positively charged.
Diana Diamonds   
 
 
DISCLAIMER
If you are pregnant or nursing, any Essential Oil/Pheromone Perfumes for you can only be worn on the tip of your nose (across your nostrils) and on the top of your ears due to unknown effects on the baby.
 
The information furnished below will not be shared in any way. It assists us in serving you. 
Dream Life Coaching does not substitute for Professional Counseling with Psychologists or Psychiatric Doctors. 
The information below does not presume to be a Medical Analysis as our Pheromone Potions should not be considered as Medical Treatment.  
 
We do not assume any responsibility or liability due to allergic reactions or misuse of any of our products.  
It is understood that you accept these conditions
when you place an order with us.
 
The FDA has not reviewed or approved any of our blends.
 



Personal Scent Profile for Personal Pheromone Potions
First Name
Last Name
Mailing address
Phone Number
Secondary Phone Number
Email Address
Best time to call
Day
Evening
Anytime
Age
Date of Birth
Place of Birth
Time of Birth (if known)
Gender
Female
Male
Pregnant
Yes
No
I am ...
an athlete
very active
active
sedentary
The top five intentions I want to manifest in my life are as follows:
Preferred Scent Category
Scents I enjoy:
Citrus/Herbal touched with Mairgold & Calendula
Green Fresh & Herbal w/ slight Gardenia/Violet
Fresh, Breezy & clean like cotton
Rare White Floral w/citrus and rich sweet amber
Sensuous w/red rose, fresh edge of green
Sensuous and warm w/kiss of vanilla
Sensual woodsy w/amber,patchouli, & raspberry
Sweet/woodsy carmel w/bergamot/orange
Herbal florals w/honeysuckle & heart's desire
Arabian musk & sandalwood w/amber & evergreen
Sweet/Sensual/Vanilla (dessert) framed by amber
Elegant/Edgy/Classy/Modern w/evergreen & red musk
Elegant understated Classic: confident & charming
Rich/deep/earthy: patchouli & nag champa w/citrus
Warm/deep/sensual: fireside w/wine, inviting
Warm/amber/spice: exotic & Egyptian incense, sweet
Warm vanilla patchouli w/raspberry & Arabian musk
Sensual Egyptian musk,amber,spikenard & sandalwood
Red tea/rare woods/amber, w/white rose & citrus
White orchid/lotus/gardenia/magnolia & sandalwood
Leather,musk,vanilla,carnation & blue tansy
Sophisticated/softly exotic & adventurous
Sophist./dreamy: evergreen/red tea/magnolia/musk
Fresh/sweet/clean & innocent
Sophisticated/fragrant modern floral with an edge
Sophisticated/woodland spicy & exciting
Vanilla/musk w/undertones of amber & sandalwood
Vanilla/red rose valentine joined with sensuality
Vanilla/woodsy in an outdoorsy and inviting blend
Herbal/floral spiked with spikenard: urban bouquet
Fruity bouquet spiked with citrus and vanilla
Manly/spicy:combo of vanilla, cinnamon & cardamon
Manly/woodsy: warm w/leather & sandalwood
Manly/sophisticated/fresh:w/herbal hint & mod edge
Manly/clean & fresh with ocean breeze
Manly/exotic/spicy: w/sandalwood & Arabian musk
Manly/cool tones w/edge - confident & charming
Manly/rich w/rare woods/leather/clean & sweet musk
My Favorite Cologne or Perfume is:
Other:
My Personality is:
introspective & quiet
shy & thoughtful
flirty & fun loving
extroverted-dramatic
moody & thoughtful
bold & active
calm & philosophical
conservative & social
impulsive & out spoken
outdoorsy & calm
outdoorsy & outspoken
dramatic & social
happy & social
tranquil & quiet
business like & social
networker & A type
social & thoughtful
Other (Any other Personality Information)
My Greatest Strength
My Greatest Weakness
My Favorite Foods are:
Sweet
Salty
Spicy
Home Cooking
Selective
My Goals Include:
Health Background
Depression
Other Medical Concerns
Current prescribed medications
Other health problems currently taking medication for or under doctor's care
Dietary overview
Daily water, coffee, carbonated beverages, alcohol, cigarettes, vegetarian
Questionaire & Personal Scent Profile
Todays Date___________ Appointment Date with Diana Diamonds____________





 
 
 
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