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Path to
Health

Please answer the questions below in as much detail as you
are able, ignore any questions which do not seem pertinent,
however, the more information you provide will help Dr. Ajit
assess your state of health more accurately.

Once you have filled out the online consultation form, you will receive some preliminary
diet and lifestyle recommendations to start incorporating into your daily life.

You can get more comprehensive and detailed advice from Dr Ajit by joining our
Path to Health™ programme, where he will be able to provide a detailed programme
which will address all the aspects of your health concerns.

All information provided is completely confidential, and will not be disclosed to any third
parties. Before you begin we recommend that you take the Know Your Body Type test
which will help establish your constitution.

Step 1 : Health & Lifestyle

* Required field

1) Please give a brief description of any health problems you have & how long they have existed? *
2) Do you take any supplements or medication? *

3) Describe your lifestyle in a few words *
4) What is important to you in your life? *
5) What sort of weather do you like? *
6) How is your memory? *
7) How would you describe the quality of your sleep? *

8) Please give a brief description of any health problems you have experienced in the past 5 years *

Step 2 : Dietary Preferences

1) What do you normally eat for breakfast? *
2) What do you normally eat for lunch? *
3) What do you normally eat for dinner? *
4) What do you snack on between meals? *
5) How long does it take before you become hungry again? *
6) Do you feel bloated after eating? *
7) Do you experience flatulence? *
8) How much water do you drink on average every day? *
9) Do you drink alcohol? *
10) Do you smoke? *

Step 3 : Physical Features

1) Do you find it easy to gain or lose weight or do you remain constant? *
2) Are your nails brittle, soft, tough or bitten & do they have any white spots or ridges? *
3) How often do you urinate & what is its usual colour and consistency? *
4) How often do you have bowel motion & what is its usual colour and consistency? *
5) Is your tongue dry or moist? *
6) Is your skin dry or oily?
7) Do you sweat easily? *
8) Are your eyes moist or dry? *
9) Is there any other information you would like to share that relates to your health? *

Step 4 : Your Details

First name *
Last name *
Email address *
Occupation

According to the Know Your Body type test, my constitution is

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