Arogya Ayurvedic Health - Book a Consultation

*First Name:

*Last Name:

*Gender:

*Email:

*Contact Number:

*Service Requested:

*Payment method:

NOTE: ALL CONSULTATIONS MUST BE PAID FOR BEFORE IN ADVANCE BY INTERNET-BANKING OR PAYPAL BY THE DATE OF APPOINTMENT. NO CHEQUES, INVOICES OR POST-SERVICE DATE PAYMENTS ARE ACCEPTED. CORRECT CASH AMOUNT ON THE DAY IS HOWEVER, ACCEPTED.

(Please note our Sevives & Fees HERE).

We will Email your the Payment Details once your Consultation has been confirmed.

*Consultation Date and Time Requested:

(Note our hours are 9:00AM - 5:00 PM, Monday- Friday, Saturdays 9:00am - 12:00PM)

Enter additional details below or about your condition:

*Karmic factors: Ayurveda deeply understands deeper genetic factors in disease, but sees karmic factors as the subtle causes behind them. Do you accept this and are you willing to adopt regimes specific to this also?

Yes No

[This just simply tells us more about you - we understand people come from a variety of backgrounds and philosophical views and accept all people].

*Diets: Often people adopt a vegan or other diet, but Ayurveda does not necessarily consider their food types to agree with bodies of all people and diseases. Are you willing to embrace a personalised diet plan for you, which may alter from various foods in your normal regime?

Yes No

[This also is just informational nature for us. The Ayurvedic model doesn't always agree with diets you may currently be on, but we do respect all reasonings for your lifestyle and dietary choices].

*Do you practise Yoga?

Yes No

If you answered YES, please answer the following question also.

If YES to the above, due to various practices in Yoga and Meditation, these can be harmful to various types and psychological complexes in Ayurveda as per tradition.

Are you willing to learn the traditional Ayurvedic and Vedic practices that can help you personally (which may require changing your current Yoga practise)?

Yes No

*Date of Birth (DD/MM/YY format):

Time of Birth (if known):

*City of Birth:

*Country of Birth:

*Tick any relevant Psychological Afflictions of the below that you have suffered from (if not, simply check "No Psychological Health Issues".

*Please breifly outline any underlying health issues that you currently have or require help with.

If none and you simply wish to enhance your health and / or learn more about Ayurveda, then simply type "N/A".

*TERMS & CONDITIONS:

Please read and accept the Terms & Conditions below before sending the Appointment Request Form:

1. Arogya Ayurvedic Health Ltd provides consultations for educational and lifestyle purposes alone. We do not claim to cure any diseases or ailments, nor do we pose as Licensed Medical Professionals. I understand that for all severe conditions, I cannot expect to have a complete recovery or cure and I do not hold Arogya Ayurvedic Health Ltd, it's Director or any of it's company representatives, nor any of its members liable for any loss, damage or injury to my person as a result. I understand my consultation is for educational purposes alone and will seek professional medical advice for all medical conditions and take full responsibility for the course of my actions.

2. I understand that all Consultations MUST BE paid for IN FULL before the date of the Consultation. No refunds are given, however rebooking applies for Consultations if one cannot make the appointment time or date stated if prior notice is given. I understand that I may bring CASH on the day, but there are no EFTPOS facilities and I will bring the correct CASH amount.

I understand if I fail to do so and payment is not made within 24 Hours [after] the Consultation, a 10% penalty will apply.

3. I understand that the date and time that I have requested for my Consultation is subject to availability and that Arogya Ayurvedic Health Ltd will contact me confirming this and liase with me if this time period is unavailable and schedule the next suitable available time for me.

4. I understand that the Consultation price stated does not include any supplementary therapies , Panchakarma therapies nor herbs that I may require and that these are at additional costs to the Consultation prices noted.

5. I shall not distribute, sell or publicly share any written materials given by Arogya Ayurvedic Health Ltd, it's Director or any of it's company representatives. I understand that this is Copyrighted material and can be held liable for its misuse. Any notes taken during the consultation must be used for you personally and not distributed or copied for any other purposes.

6. As Durgadas is a respected Practitioner and Teacher in the fields of Vedic sciences, I understand that I will receive the Traditional approach to Ayurveda, Yoga and Vedic sciences and will respect his recommendations with regards to tradition, which may differ from other Ayurvedic Practitioners and recommendations I may have formally had / been aware of.

7. I understand that in order to make the pulse diagnosis readings more accurate during the Consultation, I will make sure I come on an empty stomach (in between meals is ok) and have NOT done any exercise beforehand which can alter the reading.

Yes, I accept all Terms and Conditions

Please also complete the Birth-Dosha Quiz by clicking HERE after you have submitted this form (opens in new window, so you can open this now and you won't lose anything you have filled out on this page).

Thank you!

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