Ayurveda Wellness
Hawaiʻi
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New Client Intake
Pulse / Tongue pending
Status:
Awaiting first session
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Basics
Health History
Constitutional Assessment
Pulse · Tongue · Nail
Care Plan & Herbs
Visit History
Practitioner Notes
Client
basics.
Contact info and how we may reach them. All fields can be edited.
First Name
*
Last Name
*
Email
Phone
Date of Birth
Gender
Female
Male
Non-binary
Prefer not to say
Address
Emergency Contact
Emergency Phone
How they found us
Existing client referral
Instagram / @olaveda.wellness
Google search
Walk-in
Practitioner referral
Yelp / reviews
Other
Health
history.
Existing conditions, medications, prior care. Be specific where it helps.
Primary Concerns
*
What brought them in. Tap all that apply, then add detail below.
Sleep
Digestion
Stress
Anxiety
Pain / Tension
Burnout
Inflammation
Hormones
Skin / Hair
Energy
Mood
Other
Concern Details
Current Medications
Allergies / Sensitivities
Sleep — Hours / Quality
Bowel Movements
Appetite
Strong & regular
Variable
Low
Constant hunger
Energy Level (1–10)
Past Therapies / Modalities
Constitutional
assessment.
Prakṛti (constitution at birth) and Vikṛti (current state). Both inform the plan.
Prakṛti — Primary Dosha
Vata
Pitta
Kapha
Prakṛti — Secondary
Vata
Pitta
Kapha
Vikṛti — Currently Aggravated
Vata
Pitta
Kapha
Vata + Pitta
Pitta + Kapha
Vata + Kapha
Body Frame
Light / thin
Medium / muscular
Heavy / robust
Mind & Disposition
Climate & Season Preferences
Clinical
observations.
Pulse, tongue, and nail readings — record what you observe today.
Pulse · Nāḍī
Tongue · Jihvā
Nails · Nakha
BP (mm Hg)
Resting Heart Rate
Weight (lbs)
Height
Other Observations
Care plan
& herbs.
The written plan they leave with — food, routines, treatments, and herbal formulas.
Program
30-Day Revive
60-Day Reset
90-Day Restore & Thrive
Single sessions
Maintenance
Track
Essential (1× / week)
Focused (2× / week)
Custom
Recommended Treatments
Abhyanga
Shirodhara
Basti
Marma
Lepa (facial)
Sound healing
Yoga therapy
Pranayama
Assisted stretching
Herbal Formula
Formula Form
Powder (1-month)
Encapsulated (1-month)
Tincture (2 oz)
Ghee (8 oz)
Custom oil
Refill Due
Diet & Lifestyle Notes
Cleanse
None scheduled
2-day reset
3-day home cleanse
5-day cleanse
7-day cleanse
Custom
Cleanse Start Date
Cleanse Duration
Visit
history.
Every session, what was done, and how the client responded.
+ Add Session
Practitioner
notes.
Free-form. What you'd write on the clipboard, but searchable and exportable.
Today's Note
Long-Form Plan Reflection
Status
Active
Cleansing
Paused
Graduated
Archived
Last Visit
Next Visit
Program Day
●
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