Client Information Form

  • This field is for validation purposes and should be left unchanged.
  • Thank you for completing this form prior to your first appointment.
  • By signing below, I agree and consent to the following:
    1. I acknowledge that I am seeking Ayurvedic consultation/.counseling on my own choice without coercion.
    2. There are no refunds once you have signed up for a program.
    3. Please allow a 24hr. notice for any cancellations to avoid being charged.
    4. I understand that Ayurveda utilize assessment of imbalances in the physiology and can’t be utilized to diagnose diseases such as cancer and AIDS.
    5. I understand that Ayurvedic Medicine is not a substitute for standard medical care and that I will not forego such treatment without the consent of my doctor.
    6. Ayurvedic Healing Center LLC may require further information pertaining to my health. I grant permission to Ayurvedic Healing Center LLC to discuss my case with my medical or psychological providers.
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