Ayurveda Telehealth Intake Forms

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Print and fill out these 6 forms*. If you have the ability to fill them out electronically in the PDF, please do that. Otherwise, print them, fill them out, and scan them in, and send them to bardoacupuncture@gmail.com . If you would like to submit your forms via “snail mail”, please contact us.

*If  you are concerned about privacy, you can leave extra sensitive information (such as particular disease diagnoses) off the forms. We can discuss that information during your live appointment.

1: Informed consent to Ayurveda care: Ayurveda Informed Consent 2019

2: Informed consent to Ayurveda Telehealth Consultation: Telehealth Ayurveda Informed Consent

3: Basic Health History Intake (7 pages) Health_History_intake_form

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

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

6: Daily Routine Intake Form (1 page) Ayurveda_Daily_Routine_Intake_Form