Wellness Questionnaire

Wellness Questionnaire
What is your gender identity?


What are your primary health concerns or goals for this consultation? (Select all that apply)
Do you have any chronic conditions or significant medical history?
Are you currently taking any medications or supplements?
What type of diet do you follow? (Select all that apply)
How often do you exercise?
Do you experience any of the following sleep issues? (Select all that apply)
Do you know your Ayurvedic dosha (Vata, Pitta, Kapha)?
Have you had any prior experience with Ayurveda treatments or consultations?
Preferred consultation method:


Do you consent to sharing your health information with our Ayurvedic practitioners to provide you with the best possible care?
Do you acknowledge and accept our privacy policy and terms of service?