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Medical Intake Form

Please complete the Medical Intake Form below. Your responses will remain strictly confidential and will only be shared with the concerned Ayurvedic doctor or other physician(s) who will be involved in designing your treatment program. 

Please be thorough and detailed in your responses. The information you provide is necessary not only to understand your medical history, but also, to diagnose your health issues and to design an appropriate Ayurvedic treatment program. Thank you.
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  • About
    • About Ayurooms
    • Who is Ayurooms
    • Where is Ayurooms
    • Mission Statement
    • Mental Health Retreats
    • Our Yoga Retreats
    • Ayurvedic Retreats
    • Our Process
    • Our Pricing
    • Why Ayurooms
    • Our Values
  • Resorts
    • Luxury Resorts >
      • Backwaters & Beyond
      • Niraamaya Retreats | Best Luxury Wellness Resort in Kerala
    • Locations
    • Premium Resorts >
      • AyurSoma >
        • Palace Deluxe Room
      • Anantya Resorts
      • Cardamom Club
    • Wellness Resorts for Couples
    • Value Resorts >
      • Athreya Ayurvedic Centre
      • Nagath Ayurveda
    • All Resorts
  • Reviews
  • Packages
    • Pricing
  • Blog
    • Ayurveda Tips >
      • What is Ayurveda
      • Sex and Ayurveda
      • Self Massage
      • Concept of Eating
      • Meal Timings
      • Overcoming Tiredness
      • Why the Ayurveda Lifestyle
      • Better Version of Ourselves
      • What Makes Ayurveda Different
      • Spinal Health
    • Ayurooms Blog >
      • What is Ayurveda
      • The Best Options for Holistic Healing When You're In India
      • 7 reasons why Ayurveda is relevant today
      • Reclaiming Certainty
      • Aging Gracefully with Ayurveda
      • Tipping in India
    • Yoga Blogs
  • Visa Application
  • Medical Intake Form