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- Name
- Phone
- Address
- Your work, it's nature, duration, hours/week
- Your bedtime and waking up time
- Do you feel fresh when you wake up?
- Your fitness regime, duration, how intense, and how do you feel at the end of each session?
- Current breakfast, lunch and dinner
- Current snacks and drinks
- How do you feel when you don't exercise?
- Your height and weight
- When was the last time you were fit and healthy?
- Current diagnosis
- Duration of each illness
- Main conditions you want us to treat
- Current medication with purpose
- 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?
- Attach a document?