Ayurvedic Health & Wellness Consultation Disclosure Please enable JavaScript in your browser to complete this form.In scheduling Ayurvedic Health & Wellness Consultation with the staff and physicians at Moksha Holistic Center, I acknowledge and understand that: *1. This Consultation and any recommendations I receive will be based on the principles of Ayurveda complementary and alternative approach to health, and that the consultation and recommendations are different from and are NOT a substitute for modern medical evaluation and treatment or for preventive testing (such as blood tests, Pap smear, colon cancer screening, mammograms, and any other appropriate screening tests). I understand that Ayurveda approach uses a unique system of evaluation and health-promotion based on the concepts of balance, three doshas, and overall tissue health. I understand that the purpose of the consultation will be to assess the level of balance in the physiology and to make recommendations based on the Ayurvedic health approach to help enliven the inner intelligence of the body and restore balance to the system. *2. I understand that this consultation, and any recommendations I will receive are not for the purpose of diagnosing or treating any disease that I may have. I further understand that it is not within the scope of this consultation, or follow-up consultations I may receive, from the Moksha Holistic Center to assume responsibility for my primary health care or the treatment of specific health problems. I understand that what I will be receiving will be advice as to holistic diet, lifestyle choices, food supplements, and other natural approaches aimed at creating balance. *3. I understand that any herbal food supplements that I may be recommended have not been evaluated by the Food and Drug Administration nor are these approved by the FDA for the prevention, diagnosis, treatment or cure of any disease condition. *4. I understand that the pulse evaluation, I may receive is for the purpose of assessing overall balance and is NOT for diagnosing the presence or absence of any particular disease. N/A for online consultation. *5. I agree to consult with my chosen licensed medical professional regarding all matters pertaining to my primary or other health care matters, including any prescription medication or modern medical or allopathic treatment that I may be taking. *6. I recognize that no claims or guarantees have been made to me regarding specific medical benefits or improvements in my medical condition(s) from either consultations or recommendations. *7. I understand that the birthtime provided by me might be used for medical Jyotish to further integrate this adhidaivik (level of the far environment) level into my consultation and recommendations. This is done only if Jyotish consultation is requested. *8. I understand that technical difficulties may occur before or during the online sessions so that my appointment may not, therefore, be started or ended as intended. *9. I agree to participate in the online Health and Wellness Consultation at Moksha Holistic Center and understand that I can cancel and request refund up to 48 hours prior to consultation. *10. I have read this document and agree to the terms listed above. Contact DetailsName *FirstLastEmail *Phone *Signature *Clear SignatureSubmit