Ayurveda Consultation Client Form Please complete Section 1 and 2 of this form at least 3 days before your consultation Section 1First Name *Last Name *Street Address *City *Postal Code *Province *Email Address *Phone *May we send you text messages? *YesNoWould you like to join our eNewletter to receive updates on classes, workshops, courses, upcoming events and tips and strategies from our Online Wellness Journal? *YesNoSection 2Please give a brief description of your experience with Ayurveda *Please list three main reasons or issues for which you are seeking a consultation at this time *How would you describe your current state of health?Physical *Mental *Emotional *Daily RoutineUpon Waking *Morning Routine *Daytime Routine *Evening Routine *Sleeping HabitsAverage Sleep Routine *Characterize your average dream experience *Eating HabitsBreakfast *Lunch *Dinner *Snacks *Work Type *Work Schedule *Play *Exercise *Are you currently on any medications? If so outline what for, and how long you have been using consistently. *Are you currently using any recreational drugs? What? And Why? *Please note:The information shared during your Ayurvedic Consultation is in no way to be considered as a substitute for a consultation with a duly licensed health-care professional.SUBMITPlease do not fill in this field.