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.
Email address *
Your full name *
Mobile phone
Address (with postcode) *
Birthdate *
MM
/
DD
/
YYYY
Place of birth *
City, Country
Profession *
Nature of profession *
Is it majorly sedentary, do you need to travel a lot?, work hours, etc.
Places you have lived and duration *
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
In which of these cities you mentioned above did you feel your healthiest? *
Do you have any allergies or intolerances? *
Do you/did you use or consume any of these - tobacco products, e-cigarettes, alcohol, any kind of recreational drugs?
What are your expectations from this consultation? *
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