Note: This form is for an Ayurvedic follow-up or Ayurvedic Skype session ($100 USD). Click here for an initial Ayurvedic consultation ($175 USD). = required information Choose type of consultation ($100 USD) (required): ---Ayurvedic follow-up sessionAyurvedic session via Skype Full Name (required) Email (required) Gender (required) MaleFemale Street Address (required) Address, continued City (required) State (required) ZIP Phone (required) DISCLAIMER:----- Ayurveda offers health education to promote the proper balance between our mind, body, and consciousness. It emphasizes the importance of creating and maintaining an environment conducive to positive health. Through proper lifestyle, diet, exercise, herbs, cleansing regimes, and rejuvenation programs, Ayurveda has traditionally helped one lead a fruitful life. I understand and agree that my consultation with the ayurvedic advisor and any recommendations for a balancing program are strictly educational and are not intended as, or in replacement of, my primary health care practitioner and their treatment. The recommendations of the ayurvedic advisor are intended as balancing and strengthening to the physiology and are not intended as treatments for specific medical disorders. No attempt will be made to diagnose, treat, cure, or prevent any medical or psychological ailment. I understand and agree that the ayurvedic advisor is not conducting a medical examination for me. I will continue to seek the advice of my primary health care practitioner and any other specialist with whom I have consulted. Additionally, I will not modify or suspend any treatment program that I am now receiving, based upon the ayurvedic advisor's program. Furthermore, I understand that ayurvedic regimens are not covered by traditional medical insurance and I will assume all responsibility for payment of the consultation and any supplemental items at the time of service. I have read and agree to the DISCLAIMER shown above. After you click "Schedule Now" below, you will be directed to a secure Schedulicity website to complete payment and schedule your consultation.Your request is not complete until payment has been received.