Herbal Ayur Retreats

CONSULT THE DOCTOR

If you have a specific inquiry or problem you need to ask the doctor please use the message section to ask the doctor for his advice.

To help under stand your body type, enter your details in the form below to generate your body type report.

This form contains all the details related to your body type, health, daily routines and diet. Please provide us with real data for us to analyse and generate an accurate report as possible.

Please provide your personal details :

Name *
Address *
Email ID *
Phone
Date of Birth *
Gender *	Male Female

Please answer the following questionnaire :

Question 1.Body frame?
	Lean, thin
	Moderate build
	Rounded, tall, heavy

Question 2. Hair type?
	Thin and dry hair
	Medium colour tone with a tendency towards early thinning and or early greying
	Thick, wavy and tending towards a darker color

Question 3. Skin texture?
	Dry
	Reddish lustre
	Generally oily, soft and smooth

Question 4. Speech?
	Fast pace and talkative
	Moderate pace and confident
	A person of few but considered words

Question 5. Appetite and thirst?
	Irregular appetite
	Strong appetite and strong thirst
	Normal appetite and thirst

Question 6. Bowel habits?
	Tendency towards constipation
	Tendency towards loose and liquid stools
	Regular

Question 7. Sweating?
	Dry body, little sweat
	Tendency towards sweatiness
	Tendency toward considerable sweatiness and oily skin

Question 8. Memory?
	Quick to memorize, but tendency to forget quickly
	Moderate
	Slow to memorize, but good long term memory

Question 9. Sleep pattern?
	Often experiences disturbed, short sleep
	Moderate
	Generally long, sound sleep

Question 10. Activities?
	Generally a liking for music, dance, books and travelling
	Generally a liking for discussions, politics and doing any sports
	Generally liking for water sports

Question 11. Sensitivity towards:?
	Dry, cold and windy conditions
	Heat and sun
	Wet and cold conditions

Question 12. General personality?
	Creative, friendly, good imagination, quickly starts something but takes time to finish the task; often impatient
	Ambitious, confident, fiery personality and strong, determined will
	Well grounded, truthful, loyal, patient and satisfied in life

Question 13. Weight?


Question 14. Height?


Question 15. Occupation & Nature of Work?


Question 16. Present Complaints with full history: (How long back the symptoms started ?, How did the symptoms develop?) ?


Question 17. Past History(Previous ailments & surgery):?


Question 18. Addictions?


Question 19. Menstrual history in case of ladies?


Question 20 . Any chronic illness like Diabetes/Hyper tension/TB/Heart Diseases/ Asthma, Allergy & medicines taken now: ?


Question 21 .Have the patient's relatives had the same problem:?
	Yes No

Question 22 .Any cause known to you for the disease:?


Question 23. State of digestion, motion, micturition, appetite and sleep:?


Question 24. Marital Status:?
	Married Unmarried

Question 25. Treatments done so far:?


Question 26. Recent investigation reports (blood, urine, motion, x-ray, CT scan etc:) ?


Question 27. Blood pressure: ?


Your individual problems :