1. Ayurvedic Wellness Counselor Case Study Presentation Format
Name:

2. The current health concerns: 1. 2. 3. 4. 5.
Initials______________ Dates___________________________
Age________________ Gender__________________________
The current health concerns: 1. 2. 3. 4. 5.

3. Relevant Health History:

4. Dietary and Lifestyle Status:

5. Assessment/Observations:

6. Conclusion of Assessment:
Prakriti/Constitution:
Agni/Ama:
Dosha/Subdosha aggravated:
Dhatu/Mala affected:

7. Suggestions: Inputs: Lifestyle: Suggested Herbs/Spices: Food Water
Breath
Perception
Lifestyle:
Sleep
Activity
Daily regiment
Work
Mind care
Suggested Herbs/Spices: