Allergy Disclosure Form — KLove Spiritual Healing

Important: All KLove Spiritual Healing products are handcrafted using natural herbs, essential oils, crystals, and botanical ingredients. While every formula is made with care and intention, individual sensitivities vary. Please review ingredient lists carefully and disclose any known allergies so I can advise you on the safest products for your needs.

1. Your Information

Full Name

Email Address

Phone Number (optional)

Order # or Product(s) Purchased

2. Known Allergens — Check All That Apply

Tree nuts (almonds, walnuts, etc.)

Peanuts

Latex / rubber

Fragrance / perfume (general)

Essential oils (general)

Lavender

Eucalyptus

Tea tree oil

Cinnamon / clove

Chamomile / ragweed family

Turmeric

Arnica

Rosemary

Sage / white sage

Soy / soy wax

Beeswax

Vitamin E / tocopherol

Hyaluronic acid

Other (describe below)

No known allergies

3. Reaction Severity

Mild — minor skin irritation, redness, or itching

Moderate — hives, swelling, or breathing discomfort

Severe — anaphylaxis or emergency-level reaction

Sensitivity only — not a true allergy, but prefer to avoid

4. Additional Details

Describe any other allergies, sensitivities, or concerns not listed above

Any medical conditions I should be aware of? (optional)

5. Acknowledgment & Signature

By signing below, I confirm that the information provided is accurate to the best of my knowledge. I understand that KLove Spiritual Healing products are handcrafted with natural ingredients and that I am responsible for reviewing ingredient lists before use. I agree to contact KLove Spiritual Healing if my allergy status changes after submission.

Signature

Date

How to submit: Print and mail, scan and email to [email protected], or fill out the online form at klovespiritualhealing.com/shop