Enquiry Form 
Write your enquiries in detail. And make sure all the inputs are genuine. Note this is not a consultation form. No suggestions, prescriptions are given. We do not provide any Spa type Ayurveda services or Video chat consults.
We require these details to understand clearly and give you back the info with clarity. It saves time for you and us. 
All valid submissions shall be reviewed and we get back to you latest by 48 hours. Note: All the details will be kept confidential. Thank you for connecting with us.
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Email *
You want to enquiry about *
When do you want to schedule any of these services  *
Required
Form Submission Date *
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Mobile Number *
Email Id you use regularly *
Your Full Name *
Age *
Date Of Birth *
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DD
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Place of birth, State of Birth, Country
Exact or approximate time of birth 
Time
:
Your Present Locality *
Write in detail your enquiry so we are able to understand those. Not just the name of the diagnosis only if it is regarding health issues. *
Mention in detail the reasons behind your specific enquiry if your enquiry is NOT about health. 
*If enquiry is to promote your services or products kindly DO NOT Submit. Sorry we do not have any kind of new requirements.  
Clear selection
If the enquiry is about general medicine availability. Do not submit. We do not dispense general over the counter medicines.  *
How long has this current health issue or the problems that you are facing been there? *
How ready are you to take the time required and efforts and following the suggestions during the program?? 
 
 *
We offer different type of programs. So shall suggest the best suited ones for your issues you write in the details in this form. So you can select based on your time and affordability. 
 
NOTE:
For health issues, We do NOT offer walk-in one time remedy OPD services.

For all our programs payments needs to be completed on your selected program to start. 
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Do you understand this and clear about it?  

 *
Kindly write anything else in specific that you wish to let us know clearly in short. 
How did you get to know about us? *
What is the right time our Team to call / contact you?  *
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