Appointment Create - AyurGrid

PreSet Questionnaire

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Please Uncheck The Box,If You Don’t Want To Send The Particular Section

Habit Section

Daily Routine Section

Menstrual History Section

Do You Want To Fill The Preset Questionnaire Form Or Send Form Link to the Patient

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Book Appointment

Doctor

Dr. Megha KS

Clinic

Srushti Ayurvedalaya

Contact

9980616152

Address

1372, 1st Stage

* Patient Name

Please provide a valid Doctor id

Please provide a valid Patient id

Please provide a valid Therapy patient id

Please provide a valid Waiting id

Please provide a valid Enquiry id

* Mobile No.

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* Gender

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Location

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Other Chief complaint

Select Referred Doctor From Grid Network

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Name of Referred Doctor

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* Appointment For

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* Attending Doctors

* Consultation Type

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Packages

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Additional Services

Shirodhara

Shirolepam

Tarpanam

Karnapoornam

Upanaha and Lepanam

Body Massages

Sarvanga Abhyanga and Steam

Abhyanga Local

Sarvanga Udwarthana and Steam

Udwarthana Local

Sarvanga Kayaseka Pizhichil

Kayaseka Local

Pain Massages

Patrapinda Sweda Ela kizhi Full Body

Patrapinda Sweda Ela kizhi Local

Churna Pinda Sweda Podikizhi Full Body

Churna Pinda Sweda Podikizhi Local

Shashtika Pinda sweda Njavara Kizhi Full Body

Shashtika Pinda sweda Njavara Kizhi Local

Jaanu Basti Single

Jaanu Basti Both

Kati Basti

Greeva Basti

Hridaya Basti

Panchakarma

Basti Kashaya

Basti Sneha

Nasya

Rakta Mokshana

Vamana

Virechana

* Appointment Booking Slot

Please provide a valid Slot date

Select Time Slot For Consultation

Please Select Attending Doctors

night walking :

Smoking :

Never

/

Occasionally

/

Regularly

/

High Intake

Tobacco :

Never

/

Occasionally

/

Regularly

/

High Intake

Alcohol :

Never

/

Occasionally

/

Regularly

/

High Intake

Tea And Coffee :

Never

/

Occasionally

/

Regularly

/

High Intake

Cold Drinks :

Never

/

Occasionally

/

Regularly

/

High Intake

Fast Food :

Never

/

Occasionally

/

Regularly

/

High Intake

Late Night Sleep :

Never

/

Occasionally

/

Regularly

/

High Intake

Schedule Slotttt

Slot date

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Room

Please provide a valid Room

Patient Data

Existing Patient Mobile No.

* Mobile No.

Please provide a valid Mobile no

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