Services: Ayurvedic Spa (Beauty & Hair Care),  Yoga & Meditation Classes, Ayurvedic Courses, Online Consultation, PANCHAKARMA, Shiro Dhara, Healing Massage, Weight Loss Prg., etc. Wheelchair Accessible & plenty of free PARKING and Wheelchair Accessible  

 

 

 

LORD DHANVANTARI

The Original Teacher of AYURVEDA

 

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Payment: Strictly Credit Cards (we will phone you to ask your credit card information).

Please provide more information, it will be better for us to give you proper advice & guidance.

 

"ONLY SERIOUS INQUIRIES, PLEASE"

 

 Fee: $ 100.00 Canadian Dollars

 

Field marked by * (star), Must be Filled Out. 

* Name

First Name                       Last Name

* Sex Male Female
* Age

* Date of Birth : 

(yy/mm/dd)

Profession
 

* Address

Example of Address: 1410 Gerrard Street East

Toronto, Ontario, Canada

M4L 1Z4 (pin code/ zip code)

* Email
* Email Verification
* Phone * Fax
* Business * Cell
* Marital Status Married Unmarried
Single Divorced
   
* Blood Pressure (if you are not sure then type High / Normal / Low)
* Weight lbs (kgs x 2.2)
* Height Feet Inches
* Urine Clear Cloudy   Color
* Toilet (stool) Hard  Semi Liquid  Normal Color 
   
* Women only  
* Periods Info.:  
-Frequency
Regular    Irregular 
-Clots
Yes     No 
-Painful
Yes     No 
-Flow
Normal High
* Are you Pregnant Yes No  , if "YES" Due Date (yy/mm/dd)
   
Are you a Vegetarian Non-Vegetarian
* Addiction Alcohol Drugs
Smoking Coffee
  Tea

* 1)Major  Complaint(s) and

* 2) How old is the problem(s)
* Personal Health History
* Are you currently taking any medication
* Are you currently taking any vitamins or herbs
* Other information which you think might be helpful

 

I understand the assessment of my health problem(s), and providing all information above is correct to get right health advice from Ayurved & Acupuncture Centre with personal interest. It is entirely my choice of these services. I am / will agree with Ayurved & Acupuncture Centre’s terms & conditions.

* Today Date: (yy/mm/dd)

 

Payment: Strictly Credit Cards (we will phone you to ask your credit card information) and we may charge for frequent telephone conversation on hourly basis.

Note: if you won't reach to the "Form Confirmation Page", please click again on SUBMIT. Thank you.

Send mail to AyurvedToronto@sympatico.ca with questions or comments about this web site.                                                       
Copyright © 2004 - 2009 Ayurved & Acupuncture Centre
Last modified: 11/20/09

Designed by: Rakesh Modi

 

Disclaimer-Warning: The information on this Website is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, Information on this website is can not be evaluate or examine, because it has been collected from various sources.  If you have a medical problem or a health-related question, consult your physician or call Ayurved & Acupuncture Centre at 416- 778-9341.