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First Name
Last Name
Email ID
Conatct Number
Age
Gender	Male Female
City
Address
Your Country
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Weight
Height
Are you a Vegetarian?	yes no
Addiction of:	Alcohol Smoking Others None
Present Health Problem
Any Past History
Taking any Medication at present
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Note : Ayurveda Recommends Personal Consultation:

Please note that the most effective diagnosis can be made only after personal examination, since Ayurveda believes in treating the individual and not the disease. However, based on the details provided, Physicians will respond with their comments, recommendations for Medicines / Treatments.

Agni-Ayurvedic Village
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Morbe Village, Panvel Taluka,
Off Panvel - Matheran Road,
District Raigad, Maharashtra.

Phone: +91 75066 50605 / 606

E-mail: info@ayurvedicvillage.com

Submit details for Pre-Ayurvedic Assessment of Your Health Condition

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Agni-Ayurvedic Village E-Brochure

Agni-Ayurvedic Village
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