Intake Forms

There-Is-A-Lot-Of-Paperwork-to-Fill-Out-For-the-K-1-Petition-2Below are PDFs of the intake forms you will need to complete and bring to your first appointment. There is also a link to our Privacy Practices Policy. There are 5 Intake forms. It will take you about 45 minutes to complete them all. Please be sure all pages have printed!


1: Basic Health History Intake (7 pages) health_history_intake_form

2: Basic Ayurveda Intake Form (2 pages) prakriti-vikruti-self-intake-sept2016

3: Digestion/Toxicity/Immunity Form (2 pages) Agni_Ama_Ojas_Assessment

4: Daily Routine Intake Form (1 page) Ayurveda_Daily_Routine_Intake_Form

5: Chinese Medicine Symptoms Intake Form (2 pages) TCM Symptoms Intake Form

6: Informal Visits Short intake form (1 page) Bardo Short Intake

Privacy Policy: At your office visit you will sign an agreement to our privacy policies. Here is the full length policy. We also have a copy at our office.


For those who have already had an initial Ayurvedic assessment, you can always take this Imbalance Quiz to see how you are progressing. The fewer boxes you check, the less imbalance you are experiencing. Please contact if you have any questions:

Ayurvedic Imbalance Quiz: Imbalance quiz stand alone PDF