Consultation

Personal Details

Name (required) *

City (required) *

Email (required) *

Phone (required) *

Age (required) *

Gender (required) *

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Height (required) *

Weight (required) *

Occupation (required) *

Details of your home climate (required) *

Health Details

Name your disease (as diagnosed by conventional/modern medicine) (required) *

What are the chief signs, symptoms or complaints that made you to look at Ayurveda as an alternative health solution? (required) *

General Diet

Diet Details (required) *

Complete History Of Disease

Do your symptoms/complaints decrease or increase when you change climatic zones? (required) *

What kind of food, lifestyle or environmental changes relieve the nature of your complaints? (required) *

What kind of food, lifestyle or environmental changes trigger the symptoms of your disease? (required) *

Digestive System

How is your appetite and digestion? (required) *

Give complete details of your bowel movements, such as time of evacuations, frequency, color, consistency, regularity, irregularity and smell.(required) *

Do you see any mucus in your stool? (required)

How often do you have constipation and what do you think are the causes? (required) *

Do you pass wind? (required) *

Do you have acid reflux/heartburn? (required) *

Do you experience heaviness, discomfort or pain in the stomach after eating?(required) *

Urinary System

What is the frequency, quantity and color of your urine? (required) *

Do you feel any burning sensation while urinating? (required) *

Sleep

Do you sleep soundly? (required) *

Mental Condition:

How would you rate yourself emotionally? (required) *

How do you perceive your own financial status? What are your comfort levels with your current situation? (required) *

Treatment History

What types of treatments and medicines have you taken so far? (required) *

What have been the results? (required) *

Have you observed any side-effects? (required) *

How much do you know about Ayurveda? (required) *

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