Ayurveda Telehealth Intake Forms


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.

*These forms will be sent over email and stored electronically in password protected accounts with 2-factor authentication. If you desire enhanced security, you can leave extra sensitive information (such as particular disease diagnoses that would be damaging were there to be a privacy breach) 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