Pre-Consultation Assessment
This assessment contains 9 sections in all. Please answer these questions honestly as it will help in assessing your situation and providing guidance based on it. This assessment will help save some time during our consultation and offer more time to discuss about health and healthy practices for you.
Your responses are private and used only for consultations with Dr (Ayu) Sathyavathi S. Any information or data collected is protected under DPA (2018) and will not be unlawfully used.
* Required
Email address
*
Your email
Your full name
*
Your answer
Mobile phone
Your answer
Address (with postcode)
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Place of birth
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City, Country
Your answer
Profession
*
Your answer
Nature of profession
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Is it majorly sedentary, do you need to travel a lot?, work hours, etc.
Your answer
Places you have lived and duration
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Answer in the sequence of past to present. Duration can be approximate and doesn't have to be exact. Please mention in this sequence for each place: City - Country - Duration
Your answer
In which of these cities you mentioned above did you feel your healthiest?
*
Your answer
Do you have any allergies or intolerances?
*
Your answer
Do you/did you use or consume any of these - tobacco products, e-cigarettes, alcohol, any kind of recreational drugs?
Your answer
What are your expectations from this consultation?
*
Your answer
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