Intake Forms

There-Is-A-Lot-Of-Paperwork-to-Fill-Out-For-the-K-1-Petition-2Below are PDFs of the intake forms you will need to complete and email for your first Integrative Ayurvedic Medicine appointment. There are 5 forms total. It will take you about 45 minutes to complete them all.

Here are instructions for downloading, annotating and sending the forms: How to Email Intake Forms

1: RAA’s Basic Health History Intake RAA Long Intake Form June 2015

2: RAA’s Basic Ayurveda Intake Formraa-prakriti-vikruti-self-intake-sept2016

3: RAA’s Digestion/Toxicity/Immunity FormRAA_Agni_Ama_Ojas_Assessment

4: RAA’s Daily Routine Intake FormRAA_Ayurveda_Daily_Routine_Intake_Form

5: RAA’s Detailed Ayurvedic Constitutional Form Prakriti-questionaire_ Jan_2016


For those who have already had an initial appointment, you can always take this Imbalance Quiz to see how you are progressing. The fewer boxes you check, the less imbalance you are experiencing. Please contact if you have any questions:

RAA’s Ayurvedic Imbalance Quiz: Imbalance quiz stand alone PDF


Chinese Medicine Symptoms Intake Form. This form assists us in making a differential diagnosis based upon Chinese Medicine Theory:

RAA’s Chinese Medicine Symptoms Intake Form: TCM Symptoms Intake Form