Get Ayurvedic Consultation Intake Form

Filling out the Ayurvedic consultation intake form online is an essential step in initiating your journey towards personalized Ayurvedic health care. This form collects vital information that helps the practitioner understand your unique health needs and design suitable healing programs.

Follow the steps to complete your intake form online.

1. Press the ‘Get Form’ button to access the Ayurvedic consultation intake form and open it in your browser.
2. Begin by entering your full name in the designated field to identify yourself.
3. Provide your address, including street name, city, state, and zip code, to establish your location.
4. Input your telephone numbers, including home, cell, and work numbers, so that the practitioner can contact you as needed.
5. Fill in your email address to facilitate communication regarding your consultation.
6. Enter your birthdate and age to assist in the health evaluation.
7. Indicate your marital status and provide details about any children, including their number and ages.
8. List the name and number of an emergency contact in case of urgent situations.
9. Mention your occupation and how you discovered Dakini Ayurveda for reference.
10. Explain your reasons for seeking an Ayurvedic consultation, helping the practitioner understand your expectations.
11. Carefully read the informed consent section and provide your signature, date, and printed name to confirm your understanding and agreement.
12. Complete the confidential patient history, including past medical history, current medications, and any known allergies.
13. Document your habits, including alcohol, tobacco, and substance use, as well as your regular practices for exercise and meditation.
14. Indicate your food choices and daily liquid intake to assist in dietary recommendations.
15. Assess and record your relationships and emotional patterns to provide insights into your mental well-being.
16. Finally, review the information you have entered, make any necessary changes, and select the option to save, download, print, or share the completed form.

Complete your Ayurvedic consultation intake form online to start your path to wellness.