{"id":309,"date":"2020-07-19T01:32:55","date_gmt":"2020-07-19T11:02:55","guid":{"rendered":"http:\/\/ayurhealth.com.au\/blog\/?p=309"},"modified":"2026-01-03T12:16:43","modified_gmt":"2026-01-03T21:46:43","slug":"initial-appointment-form","status":"publish","type":"post","link":"http:\/\/ayurhealth.com.au\/blog\/initial-appointment-form\/","title":{"rendered":"PLEASE COMPLETE INITIAL APPOINTMENT FORM BELOW"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-4877878d-4fec-4ebc-a349-60e10e97438b\" id=\"wpforms-803\"><form id=\"wpforms-form-803\" class=\"wpforms-validate wpforms-form\" data-formid=\"803\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/blog\/wp-json\/wp\/v2\/posts\/309\" data-token=\"aa882e00bf195dc941c5f8d249f930bc\" data-token-time=\"1778803089\"><div class=\"wpforms-head-container\"><div class=\"wpforms-description\">This information form is requried to complete before your initial appointment. Completing the form online is easy and would reduce the waiting time for your initial appointment.<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-803-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-803-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-803-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-803-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-803-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-803-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_25\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-803-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" required><div class=\"wpforms-field-description\">DD\/MM\/YYYY<\/div><\/div><div id=\"wpforms-803-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_22\">Postal Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-803-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" required><div class=\"wpforms-field-description\">House Unit, Street, Zip code, State. \n<\/div><\/div><div id=\"wpforms-803-field_31-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_31\">Suburb <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-803-field_31\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][31]\" required><\/div><div id=\"wpforms-803-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-803-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-803-field_21-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_21\">Contact Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-803-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" step=\"any\" required><\/div><div id=\"wpforms-803-field_16-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"16\"><label class=\"wpforms-field-label\">Gender<\/label><ul id=\"wpforms-803-field_16\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-803-field_16_1\" name=\"wpforms[fields][16]\" value=\"Male\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_16_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-803-field_16_2\" name=\"wpforms[fields][16]\" value=\"Female\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_16_2\">Female<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-803-field_16_3\" name=\"wpforms[fields][16]\" value=\"Other\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_16_3\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-803-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_26\">Date of initial appointment at Ayur Health <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-803-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" required><div class=\"wpforms-field-description\">Provide the date of the first appointment and NOT the day of form completion<\/div><\/div><div id=\"wpforms-803-field_23-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"23\"><label class=\"wpforms-field-label\">Main Health Concern<\/label><ul id=\"wpforms-803-field_23\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Joint pain - Lower back \/ Spine\/ Shoulder \/ Elbows \/ Other \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_1\">Joint pain &#8211; Lower back \/ Spine\/ Shoulder \/ Elbows \/ Other<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_11\" name=\"wpforms[fields][23][]\" value=\"Migraine \/ headaches\/ dizziness \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_11\">Migraine \/ headaches\/ dizziness<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_10\" name=\"wpforms[fields][23][]\" value=\"Skin changes - Eczema \/ Psoriasis \/ Hair problems \/ Other \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_10\">Skin changes &#8211; Eczema \/ Psoriasis \/ Hair problems \/ Other<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_2\" name=\"wpforms[fields][23][]\" value=\"Body weight \/ Fluid retention problems \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_2\">Body weight \/ Fluid retention problems<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_3\" name=\"wpforms[fields][23][]\" value=\"Fertility - Libido problems \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_3\">Fertility &#8211; Libido problems<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_8\" name=\"wpforms[fields][23][]\" value=\"Cough or other Respiratory problems \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_8\">Cough or other Respiratory problems<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_9\" name=\"wpforms[fields][23][]\" value=\"Hormonal \/ Menstrual imbalances  \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_9\">Hormonal \/ Menstrual imbalances<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_7\" name=\"wpforms[fields][23][]\" value=\"Stress, Anxiety, Depression or other psychological emotional concerns\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_7\">Stress, Anxiety, Depression or other psychological emotional concerns<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_6\" name=\"wpforms[fields][23][]\" value=\"Bowel and digestive difficulties or hemorrhoids \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_6\">Bowel and digestive difficulties or hemorrhoids<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_5\" name=\"wpforms[fields][23][]\" value=\"Cancer \/ Tumor conditions\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_5\">Cancer \/ Tumor conditions<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_23_4\" name=\"wpforms[fields][23][]\" value=\"Other than listed above \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_23_4\">Other than listed above<\/label><\/li><\/ul><\/div><div id=\"wpforms-803-field_24-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"24\"><label class=\"wpforms-field-label\">Do you have history of chronic health condition in the past or currently taking any medication\/ supplements. <\/label><ul id=\"wpforms-803-field_24\"><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_12\" name=\"wpforms[fields][24][]\" value=\"No Medication \/ suppliments\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_12\">No Medication \/ suppliments<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_6\" name=\"wpforms[fields][24][]\" value=\"Taking suppliments (Vitamin\/minerals\/herbal)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_6\">Taking suppliments (Vitamin\/minerals\/herbal)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_1\" name=\"wpforms[fields][24][]\" value=\"Asthma \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_1\">Asthma<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_2\" name=\"wpforms[fields][24][]\" value=\"Diabetes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_2\">Diabetes<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_8\" name=\"wpforms[fields][24][]\" value=\"Hypertension\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_8\">Hypertension<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_7\" name=\"wpforms[fields][24][]\" value=\"Past Surgery \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_7\">Past Surgery<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_4\" name=\"wpforms[fields][24][]\" value=\"Allergy or sensitivity to any drugs, herbs or spices?\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_4\">Allergy or sensitivity to any drugs, herbs or spices?<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_10\" name=\"wpforms[fields][24][]\" value=\"Smoking\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_10\">Smoking<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_9\" name=\"wpforms[fields][24][]\" value=\"Drinking alcohol more than once a week\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_9\">Drinking alcohol more than once a week<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_24_11\" name=\"wpforms[fields][24][]\" value=\"Psychotropic drug use\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_24_11\">Psychotropic drug use<\/label><\/li><\/ul><\/div><div id=\"wpforms-803-field_32-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"32\"><label class=\"wpforms-field-label\">Family History: Please select if parents or siblings have suffered from any of the below conditions <\/label><ul id=\"wpforms-803-field_32\"><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_32_10\" name=\"wpforms[fields][32][]\" value=\"No chronic health concerns\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_32_10\">No chronic health concerns<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_32_1\" name=\"wpforms[fields][32][]\" value=\"Asthma \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_32_1\">Asthma<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_32_2\" name=\"wpforms[fields][32][]\" value=\"Diabetes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_32_2\">Diabetes<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_32_8\" name=\"wpforms[fields][32][]\" value=\"Hypertension\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_32_8\">Hypertension<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_32_7\" name=\"wpforms[fields][32][]\" value=\"Major Surgery \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_32_7\">Major Surgery<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_32_9\" name=\"wpforms[fields][32][]\" value=\"Some other chronic illness\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_32_9\">Some other chronic illness<\/label><\/li><\/ul><\/div><div id=\"wpforms-803-field_8-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"8\"><label class=\"wpforms-field-label\">How did you know about AyurHealth?<\/label><ul id=\"wpforms-803-field_8\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_8_1\" name=\"wpforms[fields][8][]\" value=\"Word of mouth\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_8_1\">Word of mouth<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_8_2\" name=\"wpforms[fields][8][]\" value=\"Internet \/ Social media\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_8_2\">Internet \/ Social media<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_8_3\" name=\"wpforms[fields][8][]\" value=\"Practitioner referral\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_8_3\">Practitioner referral<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_8_4\" name=\"wpforms[fields][8][]\" value=\"Other\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_8_4\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-803-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_14\">Private Health Fund \/ Provider for Remedial Therapy<\/label><input type=\"text\" id=\"wpforms-803-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" ><\/div><div id=\"wpforms-803-field_19-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"19\"><label class=\"wpforms-field-label\">Informed Consent: Practitioner may use a variety of Therapeutic, Remedial or Ayurveda massage techniques in your treatment.  There is always some risks associated with any health treatment. The best way to reduce the chance of a risk occurring is to answer all the questions about your health, fully and honestly, before treatment begins. The therapist will explain the treatment strategy to you before they commence and outline any associated risks in relation to your condition.  If you do not understand, or if you have specific questions, it is important that you ask for further explanation.  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-803-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_19_1\" name=\"wpforms[fields][19][]\" value=\"I understand that my health appointment will be provided by an Ayur Health Practitioner and understand that the consultation or treatment I receive is provided for the basic purpose of improving my health.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_19_1\">I understand that my health appointment will be provided by an Ayur Health Practitioner and understand that the consultation or treatment I receive is provided for the basic purpose of improving my health.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_19_2\" name=\"wpforms[fields][19][]\" value=\"I have viewed and confirmed the practitioner qualifications \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_19_2\">I have viewed and confirmed the practitioner qualifications<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_19_8\" name=\"wpforms[fields][19][]\" value=\"The basic concept of assessment and treatment procedure will be explained prior to consultation\/ therapy session.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_19_8\">The basic concept of assessment and treatment procedure will be explained prior to consultation\/ therapy session.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_19_3\" name=\"wpforms[fields][19][]\" value=\"I can ask questions regarding the techniques being used. I can also ask for techniques to be adjusted to my level of comfort or ask for a technique to cease at any time, for any reason during the procedure.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_19_3\">I can ask questions regarding the techniques being used. I can also ask for techniques to be adjusted to my level of comfort or ask for a technique to cease at any time, for any reason during the procedure.<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_19_7\" name=\"wpforms[fields][19][]\" value=\"I can terminate the assessment and treatment procedure at any time for any reason. I also understand that any illicit or abusive remarks or advances made by me will result in immediate termination of the session.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_19_7\">I can terminate the assessment and treatment procedure at any time for any reason. I also understand that any illicit or abusive remarks or advances made by me will result in immediate termination of the session.<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_19_6\" name=\"wpforms[fields][19][]\" value=\"I affirm that I have stated all my known medical conditions, and answered all questions honestly.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_19_6\">I affirm that I have stated all my known medical conditions, and answered all questions honestly.<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_19_5\" name=\"wpforms[fields][19][]\" value=\"The consultation and treatment procedure is intended as a health aid only and does not replace the need for medical emergencies, diagnosis and treatment.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_19_5\">The consultation and treatment procedure is intended as a health aid only and does not replace the need for medical emergencies, diagnosis and treatment.<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_19_4\" name=\"wpforms[fields][19][]\" value=\"I will seek medical assistance from the appropriate health care practitioner if I feel my health status needs attention. I will not hold the practitioner providing the consultation or Ayur Health clinic responsible for any change in my current health status or any loss or injury resulting from the assessment or therapy session.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_19_4\">I will seek medical assistance from the appropriate health care practitioner if I feel my health status needs attention. I will not hold the practitioner providing the consultation or Ayur Health clinic responsible for any change in my current health status or any loss or injury resulting from the assessment or therapy session.<\/label><\/li><\/ul><\/div><div id=\"wpforms-803-field_35-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"35\"><label class=\"wpforms-field-label\">Detailed Consent for Ayurveda Therapies: http:\/\/ayurhealth.com.au\/blog\/informed-consent-ayurveda-therapies\/ <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-803-field_35\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_35_1\" name=\"wpforms[fields][35][]\" value=\"I have read and fully understood the information provided in the link. http:\/\/ayurhealth.com.au\/blog\/informed-consent-ayurveda-therapies\/\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_35_1\">I have read and fully understood the information provided in the link. http:\/\/ayurhealth.com.au\/blog\/informed-consent-ayurveda-therapies\/<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_35_2\" name=\"wpforms[fields][35][]\" value=\"I understand the nature, purpose, risks, and limitations of Ayurvedic treatment.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_35_2\">I understand the nature, purpose, risks, and limitations of Ayurvedic treatment.<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_35_8\" name=\"wpforms[fields][35][]\" value=\"I understand that Ayurveda is a complementary system, not a medical substitute.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_35_8\">I understand that Ayurveda is a complementary system, not a medical substitute.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_35_3\" name=\"wpforms[fields][35][]\" value=\"I have had the opportunity to ask questions and receive clarification.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_35_3\">I have had the opportunity to ask questions and receive clarification.<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_35_7\" name=\"wpforms[fields][35][]\" value=\"I voluntarily consent to treatment at Ayur Health Ayurveda Centre.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_35_7\">I voluntarily consent to treatment at Ayur Health Ayurveda Centre.<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-803-field_35_6\" name=\"wpforms[fields][35][]\" value=\"I affirm that I have stated all my known medical conditions, and answered all questions honestly.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_35_6\">I affirm that I have stated all my known medical conditions, and answered all questions honestly.<\/label><\/li><\/ul><\/div><div id=\"wpforms-803-field_27-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"27\"><label class=\"wpforms-field-label\">Do you agree with the above information? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-803-field_27\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-803-field_27_1\" name=\"wpforms[fields][27]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_27_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-803-field_27_2\" name=\"wpforms[fields][27]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-803-field_27_2\">No<\/label><\/li><\/ul><div class=\"wpforms-field-description\">You may contact our clinic on 08 8123 8903 \/ 0470 169 933 and clarify if you have any disagreement. <\/div><\/div><div id=\"wpforms-803-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_28\">Electronic Signature: Full name in Block Letters <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-803-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" required><\/div><div id=\"wpforms-803-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-803-field_29\">Date <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-803-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" required><div class=\"wpforms-field-description\">Date of the completion of this form<\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-803-field-hp\" class=\"wpforms-field-label\">Message<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-803-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"803\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/posts\/309\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-803\" class=\"wpforms-submit\" data-alt-text=\"Sending\u2026\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":322,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-309","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ayurhealth"],"_links":{"self":[{"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/posts\/309","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/comments?post=309"}],"version-history":[{"count":7,"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/posts\/309\/revisions"}],"predecessor-version":[{"id":954,"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/posts\/309\/revisions\/954"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/media\/322"}],"wp:attachment":[{"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/media?parent=309"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/categories?post=309"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/ayurhealth.com.au\/blog\/wp-json\/wp\/v2\/tags?post=309"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}