Initial Consultation Intake Form

For Healthcare Consultation Patients

 

1) Click here to download your Initial Consultation Intake Form

 

2) At least 48 hours prior to your appointment, return completed form via:

 

Email:  courtney@dakini-ayurveda.com

OR

Fax:  415-373-4685

 

Once you have scheduled your Initial Consultation, please download, complete and submit the Initial Consultation Intake Form at least 48 hours prior to your first appointment. All Healthcare Consultation patients are required to submit this before we can proceed with your appointment.  Please be aware that this intake form does take some time to complete. It can either be emailed or faxed back to Dakini Ayurveda (you can sign the agreements in person during your consultation). Please contact us if you have any difficulty completing the intake form.

 

Please note: New patients who are only receiving bodywork are not required to complete the Initial Consultation Intake Form above but please arrive 10 minutes early to your first session in order to complete a short disclosure form.