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New Client Intake

Please answer honestly. This form integrates Ayurvedic biology and psychological parameters to help us design your personalized wellness protocol.

01. Personal Details

Full Name

Date of Birth

Phone

Current Location (City, Country)

Appetite & Digestion (Agni)

Elimination Patterns

Dry / Constipated

Soft / Loose

Regular / Daily

Sleep Quality

Dominant Emotional State (Last 3 Months)

Anxiety / Worry

Anger / Irritation

Lethargy / Sadness

Overwhelm

Current Stress Level (1-10)

Zen (1) Moderate (5) Burnout (10)

Primary Health Goals

Diagnosed Medical Conditions / Medications

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