Please complete the client form below
BEFORE your Initial Consultation.
Fill out the form online:
- Click here (thanks for your patience while the file loads). NOTE: The form has 11 pages - use the navigation arrows on the upper-right hand side of the screen to move among the pages.
- Fill in the form. You can skip the page that requires signatures; we'll have you complete that when you arrive.
- Click the "Submit" button in the upper left-hand corner of the page to send it to us electronically (we love that). You don't need to email the form to us - it will come to us automatically if you use the "Submit" button.
- After you submit the form, you'll be given the option to save a digital copy for your records.
PLEASE NOTE - It will take some time to fill out this form. You can leave the browser window open indefinitely and your work will be preserved, but don't close the window while you're still working or you will lose your entries.
Fill out the form on paper:
- Click here to download a PDF file of this form
- Save to your desktop (or another folder)
- Open the file with the PDF reader of your choice. You can download Adobe Reader for free.
- Print the form and fill it out by hand.
- Please mail it to us BEFORE your intial consultation: Valley Ayurveda, 98 Main Street, Northampton MA 01060, or you can fax it to 413-461-3277
If you have any questions or problems, let us know. Thank you very much!