Vedika Global, Inc. Igniting a community healing and wellness movement with classical Ayurveda

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*Last Name : *First Name :

Age :

Where do you live :

What do you do :

*Email :

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*Where do you hear about us?

List top 3 to 5 conditions you seek Ayurveda wellness for?

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* Please read and check YES/NO in box provided below (Mandatory)

1. You are feeling ready to change habits pertaining to food and lifestyle and behaviors and life choices versus wanting an Ayurvedic herb to fix you? Yes / No

2. You are willing to try new Ayurvedic recipes in lieu of the cuisine (flavor) you are used to? Yes / No

3. You have the time and commitment to dedicate to this process? We ask for a commitment to 4-6 appointments. Yes / No

4. You are comfortable with this in-depth process and the time it takes to investigate and discuss your case before you can turn around and walk away with remedies? Yes / No

5. You have the monetary resources to dedicate to this process? This includes cost of organic fresh foods, cost of accessional herbs and other self care supplements that will be suggested to you.
Yes / No

NOTE- If you have read everything we have written for your benefit and answered Yes to the queries we have mentioned above then there is a good chance that you will benefit from our style of coaching.

* I have read the 6 Wellness Program Features enumerated above before applying for program acceptance

* I am aware that that since Vedika Seva is a teaching clinic more than one apprentice/Intern may be present at my appointment

* I understand that Vedika Seva is closed during August and from November 14th to January 14th. I understand that during that time there will be minimal support available

* You are able to come on any one Thursday of the month between 3 to 5 pm for a (up to) 30 minute appointment to meet with a clinic supervior / senior doctor.

* I understand that due to high number of applicants there is a waiting list. I understand that it may take up to several weeks before the intake appointment can be scheduled