Intake Forms

There-Is-A-Lot-Of-Paperwork-to-Fill-Out-For-the-K-1-Petition-2Below are PDFs of the intake and legal forms you will need to complete and bring to your first appointment. You may also send them ahead of time. There are 6 Intake forms. It will take you about 45 minutes to complete them all.

 

1: Basic Health History Intake health_history_intake_form

2: Basic Ayurveda Intake Form: prakriti-vikruti-self-intake-sept2016

3: Digestion/Toxicity/Immunity Form: Agni_Ama_Ojas_Assessment

4: Daily Routine Intake Form: Ayurveda_Daily_Routine_Intake_Form

5: Detailed Ayurvedic Constitutional Form Prakriti-questionaire_ Jan_2016

6: Chinese Medicine Symptoms Intake Form: TCM Symptoms Intake Form

Legal Forms: These must be printed in color (or we can provide you with them at your visit).

1: Arbitration Agreement & Informed Consent to Acupuncture/Chinese Medicine Treatment/Consultation  a2004 – arbitration agreement and informed consent – fed(1)

2: Informed Consent to Ayurvedic Medicine ayurveda informed consent 2019

why sign an arbitration agreement? about arbitration

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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 rosewoodayurveda@gmail.com if you have any questions:

Ayurvedic Imbalance Quiz: Imbalance quiz stand alone PDF

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

Chinese Medicine Symptoms Intake Form: TCM Symptoms Intake Form

 

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