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    Patient Name:-D.O.B Mobile: - Email:-: Kayakalp Chikitsa Intake Form

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    Ramakant Singh
    This document contains an intake form for Kayakalp Chikitsa treatment that collects a patient's name, date of birth, mobile number, and email. It also includes an informed consent section where the patient agrees to provide accurate medical information, notify the practitioner of any pain during treatment, maintain appropriate conduct, update the practitioner on any health changes, and not hold the practitioner or establishment liable for any issues that may arise.

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    Patient Name:-D.O.B Mobile: - Email:-: Kayakalp Chikitsa Intake Form

    Uploaded by

    Ramakant Singh
    23 views1 page
    This document contains an intake form for Kayakalp Chikitsa treatment that collects a patient's name, date of birth, mobile number, and email. It also includes an informed consent section where the patient agrees to provide accurate medical information, notify the practitioner of any pain during treatment, maintain appropriate conduct, update the practitioner on any health changes, and not hold the practitioner or establishment liable for any issues that may arise.

    Original Description:

    admission form

    Original Title

    Kaya Kalp1

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    This document contains an intake form for Kayakalp Chikitsa treatment that collects a patient's name, date of birth, mobile number, and email. It also includes an informed consent section where the patient agrees to provide accurate medical information, notify the practitioner of any pain during treatment, maintain appropriate conduct, update the practitioner on any health changes, and not hold the practitioner or establishment liable for any issues that may arise.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    23 views1 page

    Patient Name:-D.O.B Mobile: - Email:-: Kayakalp Chikitsa Intake Form

    Uploaded by

    Ramakant Singh
    This document contains an intake form for Kayakalp Chikitsa treatment that collects a patient's name, date of birth, mobile number, and email. It also includes an informed consent section where the patient agrees to provide accurate medical information, notify the practitioner of any pain during treatment, maintain appropriate conduct, update the practitioner on any health changes, and not hold the practitioner or establishment liable for any issues that may arise.

    Copyright:

    © All Rights Reserved
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    of 1

    KAYAKALP CHIKITSA INTAKE FORM

    PATIENT NAME:-
    D.O.B MOBILE :-
    EMAIL:-

    Informed Consent:- The above information is accurate to the best of my knowledge and I freely give my permission
    to Nadi Vaidhya Saurabh.I agree to inform Nadi Vaidhya Saurabh of any experience of pain during the session I understand
    theis does not deter me from seeking treatment for medical conditions.I understand that no inappropriate comments or
    counduct will be tolerated.Any indication of such behavior will automatically end the session.
    I agree to update theapist's in regard to changes in my health and understand that there shall be no liability on the
    therapist's Nadi vaidhya saurabh part should I forget to do so.I agree to hold harmless the establishment all management
    including volunteers from and against any and all claims. I agree to handle suit at its sole experise and agree to bear all
    cost related even if claims ets,are groundless ,false and fraudulent

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