Siblings

Welcome

Our Journey always start by knowing you better. 

The first step is for you to let us know what is happening in your life and how things have manifested. 

There will be a sequence of questions which we ask you to reply in much in depth as you can or want at this stage. 

This will help us getting a first idea of how we might help you in the short-term and beyond. 

We will then find some time for a conversation where we will depend some of what you told here in this form. 

If you feel that this is too upsetting and you cannot follow our normal procedures, then please open the chat box and let us know that you need to follow immediately to the face-to-face consultation and we will then go through the form together. 

Remember we are here to find a way to help you manage and hopefully improve. This will require lots of strength and will from your part. We are here to give you the tools and to support you along the way. 

With our arms wide open, welcome to our group.

The Yoga Cikitsa Team.
Please, provide us with the requested details:
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Let us know know more about current situation

This section of the introduction form will allow us to understand what you are going through right now.

Please, fill all text areas with as much detail as you like.

1. Please, let us know how you feel right at this moment:

PoorFairGoodVery goodExcellent

2. What health issues are affecting you?

3. How does this affect your day-to-day activities?

4. What would you like to work/improve in the sort-term?

(i.e. 2 to 4 weeks)

5. What would you like to work/improve in the medium-term?

(i.e. 2 to 6 months)

Please give us information on:

In yoga we divide our being in multiple layers, body, energy, basic mental functions, emotional and intellectual.

We strongly believe each level of existence influence each other and can help each other on the necessary change.

In this section we are looking to find out what is influencing your current condition.

Please, fill all text areas with as much information as you want to provide us with:

6. Pain/Stiffness

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Front
Back

7. Hight, Posture & Mobility

8. Weight & Diet

9. Smoking, Alcohol Intake & Other Recreational Substances

10. Professional, Physical & Leisure Activities

11. Breathing & Sleeping Patterns

(incl. quality & duration, medication)

12. Blood Pressure, Pulse & Sugar Levels

(incl. medication)

13. Digestion, Bowel Movements & Gastric Issues

(incl. medication)

14. Hormonal Imbalances

(incl. medication

Please give us information on:

Please provide us more information on your emotional self. 

We encourage you to give as much detail as you can at this time.

We will revise these in our sessions. 

There is no judgment, there is no punishment, just understanding.

15. What is a normal day for you?

16. What are your family, social, economic circumstances?

17. What's your general mindset, or how do you perceive life?

How do you see yourself? How do you think others see you? And, how much does this matters to you?

18. How are you emotionally?

Are others aware of how you feel?

19. How is your current mood and how does it tend to fluctuate?

20. How are your Stress and Anxiety levels?

21. Do you feel you are holding to some worry, anger, guilt, any traumas, fears or phobias?

Please describe to the best of your abilities.

22. What brings you joy?

We just need to submit your information

Thank you for providing us with all the information we ask.

We will now assess your circumstances. The nest step is to book a free appointment. Please make sure you allow for, at least two days so we can properly analyse and guide you towards the right treatment.

We will take care of and respect all the information you have provided us with.

If you have any concern, please refer to our Privacy Policy or contact us through the Chat Box.

If you are feeling this is an emergency, please do reach us on the Chat Box and we will be with you asap.