Fill out the form below and one of our Ayurvedic physicians will reply to you as soon as possible.
With your Ayurvedic assessment you will also receive our newsletter and free booklet called
Ayurveda Approach to a Healthy Daily Routine. This very informative PDF document introduces
you to the self-health care principles of Ayurveda.
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First Name*: |
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Last Name*: |
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E-mail address*: |
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Repeat E-mail address *: |
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Country*: |
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| Your present health problems * |
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Other information about you which the doctor should know |
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Blood pressure |
If known |
Weight |
Kg. |
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cm.
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| Are you vegetarian? |
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Dependencies: |
Alcohol
Drugs
Smoking
Cafeine |
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Sex: |
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Age: |
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Is your memory?: |
Short
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Is your digestion?: |
Irregular
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Is your capacity for food intake?: |
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Which group of tastes do you like most?: |
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Sleep: |
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Are your bowel movements?: |
More than 1-2 times/day
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Body Weight: |
Medium size, moderate, strong
Large, plump, fleshy
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Skin: |
Dry, rough, cold hands-feet
Slightly unctuous hot hands-feet
Unctuous
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Joints: |
Cracking, loose rigid, unsteady, tremulous
Flabby
Strong, well knit, firm, compact
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Abdomen: |
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