panchtatva – Panchtatva Yog Ashram

Application for Admission

I hereby authorize Panchtatva Yog Ashram & Research Centre to use the Telehealth practice platform for telecommunication for evaluating, testing and diagnosing my medical condition.

First Name *

Last Name *

Mobile *

Occupation

Age *

Gender *

Preferred Time of Contact

Disease Details with Duration

Any surgery within 6 months?

Any type of allergies

Heart ailment in the past

Present Medication

Reasons you are seeking health care?

Weight loss Digestive support Detox Stress management Sleep management Cardiovascular protection Dietary advice Pain management Others

Any Other Information

Quick Links

Useful Links

Our Team

Terms and Conditions

Chat On Whatsapp