Wellness Health Questionnaire

How did you find out about the Prama Wellness Center?
  
Do you engage in regular physical exercise?
 
Do you suffer from any kind of sleeping problems?
 
If yes, what kind of sleeping problems do you have?
Which of the following are part of your dietary habits? (Check all that apply)
   
How often do you snack between meals?
Before eating a meal, you are usually
How much water do you drink in a day, not including water taken near or during meals? (1 Liter = 4 glasses)
How often do you fast?
If you fast regularly, how many times per month do you fast and when was the last time you fasted?
What types of fasting have you experienced? (Check all that apply)
   
How often do you drink alcohol?
How often do you smoke cigarettes?
How often do you take medicines?
Please provide the names of the medicines that you are currently taking?
Have you had any operations?
 
If yes, what kinds of operations have you had?
How often do you have bowel movements (stool)?
Do you have gas problems?
Do you have any allergies?
 
If yes, please list them below:
Do you frequently have body pain?
 
If yes, please describe the types of body pain that you are experiencing?
Please list any stress or emotional issues that you feel may affect your everyday activity and physical health.
Please list any psychoactive drugs you are currently taking.
Please describe any other health problem that you have?
Please provide any other relevant information.
Disclaimer: This health form is not used to diagnose or treat any disease. When making changes to your diet or lifestyle, you are advised to consult with your doctor.
Cancel

Upcoming Events

Finding Unity – Within & Without

Finding Unity – Within & Without

You may be familiar with the story of the elephant and the six blind men, or a similar tale. As they inspect the elephant, each of the six men gain a different understanding of what the elephant is according to what they touch. One feels a wall, another a hose, a fan,...

The Yogic Path to Truthfulness

The Yogic Path to Truthfulness

There are facts, there are truths, and there is what we believe. And they can vary greatly. For one thing, there are many ways to understand these concepts. Some people consider facts as verifiable pieces of information which are determined by research or some kind of...

Diet for a Healthy Planet

Diet for a Healthy Planet

Fifty years ago, when Frances Lappé wrote her ground-breaking book, Diet for a Small Planet, the idea that the food we eat was significantly affecting our health and that of the earth was a novel, if not radical, idea. Not only did Lappé’s book overturn popular myths...

Don’t Miss our Next 10 Day Juice Cleanse Retreat!

Don’t Miss our Next 10 Day Juice Cleanse Retreat!

by Ramesh Bjonnes “A seven-day retreat is ideal, a 10-day one is even more beneficial.” --from the website for the film Food Matters   Usually only once a year we organize a 10 day juice cleanse at the Prama Wellness Center. Most of our wellness retreats last 3...

SIGN UP FOR OUR NEWSLETTER

Stay up to date with the latest news and promotions.

You have Successfully Subscribed!

We do not share any personal data with third parties.

Share This
Join Waitlist We will inform you when there is an opening for this retreat. Please leave your valid email address below.