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Your height and weight *

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Family history *

Your work, it's nature, duration, hours/week *

Your bedtime and waking up time *

How d you feel when you wake up? *

Your fitness regime, duration, how intense, and how do you feel at the end of each session? *

Time of your breakfast and what do you eat *

Time of your lunch and what do you eat *

Time of your dinner and what do you eat *

Usual snacks, how often, when *

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Do you use alcohol, smoking, betel, tobacco - if so, how often, how much? *

Currently diagnosed conditions, and when was the diagnosis? *

Conditions you want us to treat *

Which conditions/symptoms are improving? *

Which conditions/symptoms are not responding? *

Which conditions/symptoms are NOT improving? *

Do you have any allergy or sensitivity - when did they start - how bad are they - how do you manage? *

Any health or energy issue during any particular season - if so, how do you manage? *

When (time of the day, season of the year etc) do you feel better? *

When do you feel worse? How do you manage it? *

How is your stress level at work? *

How is your stress level at home? *

What are your major concerns apart from your health? *

Have you had Ayurvedic treatments before? If so, when and where? What was the result? *

How did you know about vaidyagrama? *

Please attach the diagnosis, scan/blood reports, photos of your affected area etc.

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SOCIAL MEDIA

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Hospital

Vaidyagrama Ayurveda Healing Village
A unit of Punarnava Ayurveda Limited
15(1) Rottikaranur Road,
Thirumalayampalayam Post, Madukkarai via, Coimbatore, Tamilnadu 641105, INDIA

Admin

Punarnava Ayurveda
A‐21, Parsn Galaxy, Nanjundapuram Road, Coimbatore‐ 641036. Tamilnadu INDIA.

PHONE

+91 422 2364200
Tollfree Number in India: 18001232230

Health info sharing

Initial consultation

confidential

SOCIAL MEDIA

CHOOSE a LANGUAGE

ACCREDITED

Hospital

Admin

PHONE

pAGES

contact us

Health info sharing

Initial consultation

confidential

SOCIAL MEDIA

CHOOSE a LANGUAGE

ACCREDITED

Hospital

​​​Admin

​PHONE

pAGES

contact us

Admin

PHONE