Ayurvedic Initial Consultation Form

Name *

First Name

Last Name

Date of Birth

MM

DD

YYYY

Declaration & Informed Consent *

Please ensure you have read our Terms & Conditions and Privacy Policy (in the footer below this form)

I have been informed of the Beinspired Ayurvedic Process and am willing to proceed

The above information is correct and complete. I consent to these details being kept securely and confidentially

I am aware that I can ask to view my details at any time

I am aware I can withdraw consent at any time and ask for my data to be destroyed

I am aware that my data will be destroyed once I cease to attend sessions