Forms
Client Declaration & Consent Forms
Last updated: 28 July 2026
Before your first appointment we ask every client to complete a short health questionnaire and consent form. It helps us make sure your treatment is safe, appropriate and tailored to you.
1. Complete and submit securely online Preferred
Fill in the New Client Health Questionnaire on your phone or laptop — save your progress, sign on screen, and submit through our encrypted online form. Takes about 5–10 minutes.
Complete online now →2. Complete on paper at the studio
Prefer paper? Please arrive 10 minutes before your appointment and we will provide the form for you to complete on site before your treatment begins.
You may also print the form in advance and bring it with you completed:
New Client Health Questionnaire & Consent Form
For your first visit. Covers your contact details, health history, allergies and sensitivities, and the client declaration and consent.
PDF · 4 pages · fillable on screen
Download formTreatment Consent & Health Update
For returning clients. A short check that nothing important has changed since your last visit, plus consent for today's treatment.
PDF · 2 pages · fillable on screen
Download form3. Telephone assistance
If you would like help completing the form, or would prefer to give your details by phone, please call +44 7377 732335 and we will be glad to assist.
If none of the above are workable for you, you may return a completed form to contactus@theayurchikitsa.com as a last resort. Please note that ordinary email is not an encrypted channel; the online or in-studio route is preferred for any health information.
What the declaration says
The full text of the client declaration and informed consent, as it appears in the New Client Health Questionnaire & Consent Form:
- I confirm that the health and personal information I have provided is accurate and complete to the best of my knowledge. I agree to inform the practitioner of relevant changes before future appointments.
- I understand that The Ayur Chikitsa provides complementary wellbeing services based on traditional Ayurvedic principles, and does not provide medical diagnosis, medical treatment or emergency care.
- I understand that Ayurvedic consultations, massage therapies, lifestyle guidance, meditation, Reiki and related wellbeing practices do not replace advice or treatment from my GP, consultant, pharmacist, mental-health professional or another regulated healthcare professional.
- I will not stop or change prescribed medication without consulting the qualified healthcare professional responsible for my care.
- I have disclosed relevant medical conditions, medication, allergies, sensitivities, pregnancy, recent surgery and injuries.
- I understand that the practitioner may modify, postpone or decline a service where there is a reasonable safety concern, or where the requested service falls outside their professional scope.
- I understand that I may ask questions, request adjustments, decline any part of a treatment, or withdraw my consent at any time.
- I consent to receiving the consultation or therapy agreed with the practitioner.