This online form is for collecting data on the use of essential oils in palliative care and hospice patients.

Please choose Patient or Caregiver OR Palliative or Hospice Organization
List the diagnosis most associated with the symptom being managed by the essential oil. (Example: Pancreatic Cancer & Nausea)
Please enter the name of the supplier
Select all essential oils used in the blend
Please indicate all lot numbers used.

Consent for Online Research