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02 9904 7754 • 17 Orchard Road Chatswood Sydney 2067 www.ayurvedaelements.com [email protected] ABN 17-335-545-355 Personalised Ayurvedic Health Program for ………………………………………… …………2008 by Ayurvedic Doctor Rama Prasad Bachelor of Ayurvedic Medicine & Surgery. Enquire about 1 year Ayurveda Certificate Training Rejuvenation Tour Health Resorts a;yur;roGys;w:ymè wishing you long, healthy, fulfilled life

Travel Consultation Case Sheet

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Page 1: Travel Consultation Case Sheet

02 9904 7754 • 17 Orchard Road Chatswood Sydney 2067 www.ayurvedaelements.com • [email protected]

ABN 17-335-545-355

Personalised Ayurvedic Health Program for

…………………………………………

…………2008

by

Ayurvedic Doctor Rama Prasad Bachelor of Ayurvedic Medicine & Surgery.

Enquire about  1 year Ayurveda Certificate Training 

Rejuvenation Tour Health Resorts 

a;yur;roGys;w:ymè

wishing you long, healthy, fulfilled life

Page 2: Travel Consultation Case Sheet

My Permanent Body ConstitutionWhat’s the shape of your body when you are/were healthy?

Ether Air Fire Water EarthTall Small Angular Soft SolidDelicate Short Triangular Rounded RectangularSlender Light Muscular Curvaceous Heavy bones

Elements In Universe and LifeEther Air Fire Water EarthWisdom Mobility Transformation Attraction IntegrityBliss, stillness Rhythm Heat Fluidity StabilityTranquility Cycles Intensity Bond SolidityCalmness Lightness Precision Flexibility Gravity

What is your constitution?

My current Physical ExcessEther Air Fire Water EarthDepletion Irregular Over heated Sluggish RigidityLoss Improper, twists Acidity Mucusy ClotThinning Aches, pain Redness Weight gain GrowthWaning Dehydrated Burning Excess fluid Spur

My current Psychological ExcessEther Air Fire Water Earth

Absence Fluctuating, shifty Irritable Clingy StubbornnessLoss Mental blockage Easily angered Sluggish InflexibilityIrrational Confusion, worry Easily impatient Greedy OverpoweringAnxiety Insecurity, fear Frustration Procrastination Rigidity

Ayurveda ElementsCourses & Consultation in Sydney, Canberra and Melbourne

Phone/fax: 02 9904 7754 17 Orchard Rd Chatswood Sydney 2067

[email protected]

Mos

t im

bala

nces

are

due

to o

veru

se, u

nder

us

e or

abu

se o

f “e

lem

ents

of

life

”. A

ny

imba

lan

ce c

an o

ccur

to

any

body

typ

e.

Att

ribu

tes

and

geom

etri

cal

shap

es

of

elem

ents

are

per

man

ent.

It

is i

mpo

rtan

t to

un

ders

tand

ing t

he ‘t

ype’

and e

ngag

ing i

t wis

ely.

Page 3: Travel Consultation Case Sheet

Elements and lifeCategories Ether Air Fire Water Earth

Exercise Meditation Aligning Cardio Stretch Toning

Awareness Breathing Sprinting Yoga (asana) Weights

Nutrition Philosophy Fiber Digestives Carbs, fats Protein

Fasting Freshness Metabolic Essential fats Minerals

Room Spacious, uncluttered

Everything, everywhere

Efficiently organised Convenient, accessible

Brick walls, timber floors

Tools, furniture

Minimal All shapes, sizes, variety

Most efficient, fastest, latest

Comfort items, food, cushions

Lasting, reliable, strong

Vacation Meditation retreat Surprise me, unpredictable

Competitive, challenging

Water side, food, friends, cushions

Physical, getting hands dirty

Silent, wilderness Something totally outrageous

Mountain biking, white water rafting

Pampering, yoga retreat

Outback, gardening, renovation

Olympic High jumpers Marathoners Sprinters Gymnasts Weight lifters

My permanent body type is …………… …………… element predominant

My current work is …………… …………… element predominant

My current lifestyle is …………… …………… element predominant

My current relationship is …………… …………… element predominant

Changes I need to make …………… …………… ……………………

……………………………………………… …………… ……………………

My Constitutional AbilitiesEther Air Fire Water EarthCreative Adaptable Analytic Listener StructuredMeditator Multitasking Driven Carer MethodicalOpen Easy going Challenging Gentle Hands onCharitable Communicator Competitive Tolerant Routine loverPhilosopher Dancer Result oriented Nurturer SupervisorScientist Teacher Precise Parental AdministratorThinker Musician Sharp, intense Chef ManagerDreamer Performer Marketer Nurse Coach/ Trainer

Page 4: Travel Consultation Case Sheet

Ayurvedic Tongue Analysis | Ayurveda Elements | 02 9904 7754

Name ……………………………………… Date ………………… Location ……………………………

…………………………………………… ……………………………………………………………………………………………………… …………………………………………… ……………………………………………………………………………………………………… …………………………………………… ……………………………………………………………………………………………………… …………………………………………… ……………………………………………………………………………………………………… …………………………………………… ………………………………………………………………………………………………………

…………………………………………… ………………………………………………………………………………………………………

Copyrighted to Ayurveda Elements 2005

Page 5: Travel Consultation Case Sheet

Personalised Program for …………………………………………………………………………………………………………

……………………………… tablets at least half hour before breakfast and dinner or at 6 am and 5 pm.

……………………………… tablets at least half hour before breakfast and dinner or at 6 am and 5 pm.

……………………………… powder after breakfast, lunch and dinner, along with 50 ml water.

Advice 1

Advice 2

Breakfast, lunch and two snacks are good for the time being. The last snack can be slightly larger and can be taken at around 6 pm. Chew everything at least for 25 times. Sip water. Don’t gulp it down. No solid meals after 6 pm. Food and drinks should be warm. Avoid hot spices and oils; fermented and refined; additives and colours in food during this 6 weeks.

Therapies 20 minute self massage with sesame oil before taking a warm bath 2-3 times weekly.

Cleanse

Exercise Walk for 20 minutes daily, with long stride and deep breathing. Low impact cardio, for 30 minutes to sweat.

Yoga asana Continue.

Meditation Daily at bedtime / morning / after work.

Light Alkaline shopping list.

Gall bladder cleanse. Information given

Sinus cleanse.

Important: 1. It is a possibility that the client may go through a ‘healing crisis’ during some treatments though rarely. Symptoms and signs can vary from simple flus and colds to diarrhoeas, constipation, bloating, headaches, rashes, dizziness etc. They will go away with adequate care. In this case please email Rama immediately. 2. If you need any further short explanations or clarification please email Rama. His office will contact you as soon as possible.

Dr. Rama Prasad B.A.M.S.

Phone/fax 02 9904 7754 Web: www.ayurvedaelements.com

Email: [email protected] 17 Orchard Road Chatswood Sydney 2067

ABN 17-335-545-355

Page 6: Travel Consultation Case Sheet
Page 7: Travel Consultation Case Sheet

Tax Receipt

Name Date Receipt number

D D D

Service Category Fee/charge Consultation (Herbal / Natural Therapy / Ayurveda) Fee .00

Tablets .00 .00 .00 .00 .00

Practitioner only medicines

.00

Subtotal

$………00

Rama Prasad, Ayurvedic Physician, Natural Therapist and Herbalist.

Health Funds and Provider Numbers ATMS 9364 Australian country health 21011871 HCF A160029 Australian Health management 21011871 Illawarra Health Fund 21011871 CBHS 9364 Manchester Unity 9364 Government Employees 21011871 Mutual Health 21011871 Grand United 01079930 AHM (Australian Health management) 21022412

Ask your health fund about Ayurveda.

Have you ever Bathed an elephant?

South India Tour 2009 • 14 days - beachside, mountaintop and backwater rejuvenation • Indulge in healthy and yummy traditional cuisine • Enjoy houseboats, palaces, temple and much more • Night trekking, bamboo rafting, spice plantation visits • Ride and bathe an elephant and many more activities…  For prices and exact dates, please call 02 9904 7754 or log on to our website. Your guide, Rama Prasad is an Ayurveda doctor and Kerala local.

Phone/fax 612 9904 7754 17 Orchard Road Chatswood Sydney 2067

Email: [email protected] Web: www.ayurvedaelements.com

ABN 17-335-545-355

Page 8: Travel Consultation Case Sheet

My current health status After being on the ayurvedic program for a month is as follows. Fill in the blanks if applicable.

1. The easiest part of the program is

2. The most difficult part of the program is

3. The most satisfying part of the program is

4. I need more clarifications on

5. I couldn’t do this

6. I followed the new nutrition program about ……% perfectly

7. I followed the new cleansing about ……% regularly

8. I followed the new practices about ……% perfectly

9. My exercise was ……% regular/perfect

10. I took the medicines about ……% regularity

11. The amount of medicines yet to be finished is ……% in quantity

12. Overall I followed the advise about ……% perfectly

13. My energy feels better by ……%

14. Being on the program, I wake up refreshed by ……%

15. Being on the program, my mental clarity is better by ……%

16. Overall I am better by ……%

17. I feel definite the improvement in the following area

18. The problems still to be improved is/are

19. New problems are

Page 9: Travel Consultation Case Sheet

Som

e ba

sic ru

les:

Drin

k yo

ur so

lids

Eat y

our l

iqui

ds

FAVO

UR

The n

atur

e of y

our m

eal s

houl

d be

light

, war

m, f

resh

, gen

tle, m

oist

and

soft

in n

atur

e.

REDU

CE/S

TOP

1.

Over

eatin

g: se

vera

l mea

ls or

ea

ting t

oo m

uch.

2.

La

te /

heav

y mea

ls: av

oid/

redu

ce

solid

s afte

r 6.3

0 PM

. 3.

To

o col

d / h

ot.

4.

Oils

& fa

ts.

5.

Fried

, drie

d foo

ds.

6.

Anyt

hing

dire

ctly f

rom

the f

ridge

. 7.

Co

lour

ing,

addi

tives

, flav

ourin

gs.

8.

Conc

entra

ted/

refin

ed fo

od (e

g.

pizz

a, pa

sta)

9.

Yeas

t, m

eat &

eggs

. 10

. Cof

fee,

tea &

alco

hol.

11. S

ugar

s & w

hite

flou

r. 12

. Car

bona

ted d

rinks

. Ke

y ✓ F

avou

rabl

e ❑

Mod

erat

ely

▲ tw

ice a

wee

k ✖

Avo

id

REGU

LAR

USE

VEGE

TABL

ES

Artic

hoke

As

para

gus

Avoc

ado

Bean

s Be

en sp

rout

s Be

et gr

eens

Be

etro

ot

Bitte

r melo

n Br

occo

li Ca

bbag

e Ca

rrot

Caul

iflow

er

Celer

y Ce

lery l

eave

s Cu

cum

ber

Daiko

n Gr

een

bean

s Le

afy g

reen

s Le

eks

Lettu

ce

Okra

Pa

rsley

Pa

rsnip

s Pu

mpk

in

Radi

sh

Spin

ach

Spro

uts

Squa

sh

Swee

t pot

atoe

s Ta

ro ro

ot

Turn

ips

Zucc

hini

FRUI

TS

Appl

es

Bana

na

Berri

es

Cher

ries

Coco

nut

Cran

berri

es

Date

s Fig

s Fr

uits

–soa

ked

Grap

efru

its

Grap

es

Kiw

i fru

it Le

mon

/ Lim

e M

ango

M

elons

Pa

paya

Pe

ache

s Pe

ars

Persi

mm

on

Pom

egra

nate

St

raw

berri

es

GRAI

NS

Barle

y Bu

ckw

heat

Br

ead -

yeas

t fre

e Co

rn

Cous

cous

M

illet

Oat b

ran

Pasta

(rice

/cor

n)

Polen

ta

Rice

-pas

ta/n

oodl

e Ry

e Sa

go

Seita

n

BEAN

S Ad

zuki

bean

s Bl

ack b

eans

Bl

ack e

yed

bean

s Ki

dney

bean

s Le

ntils

Lim

a bea

ns

Mun

g bea

n Na

vy be

ans

Peas

Pi

nto b

eans

DA

IRY

A2 m

ilk

Butte

rmilk

Ri

cotta

chee

se

Low

fat y

oghu

rt NU

TS &

SEED

S Co

conu

t Pu

mpk

in

Sunf

low

er se

eds

Sesa

me s

eeds

DR

INKS

Ap

ricot

juice

Ch

erry

juice

Co

conu

t milk

Cr

anbe

rry ju

ice

Lem

on ju

ice

Pine

appl

e jui

ce

Peac

h ju

ice

Pear

juice

Pr

une j

uice

Ri

ce m

ilk

HERB

S SPI

CES

Allsp

ice

Anise

As

afoe

tida

Basil

Ba

y lea

ves

Card

amom

Ce

lery s

eeds

Cin

nam

on

Clove

s Co

riand

er

Cum

in

Fenn

el Fe

nugr

eek

Ging

er

Herb

s-fre

sh

Lem

on th

yme

Licor

ice

Nutm

eg

Parsl

ey

Pepp

er

Rose

mar

y Sa

ge

Tarra

gon

Thym

e Tu

rmer

ic Sa

lt CO

NDIM

ENTS

Ap

ple c

ider

vin

egar

Ch

ocol

ate,

bitte

r Ch

utne

y, sw

eet

Coria

nder

leav

es

Curry

leav

es

Olive

M

iso br

oth

Parsl

ey

Tam

ari

TEAS

Al

falfa

Ba

sil

Blac

kber

ry

Burd

ock

Cham

omile

Ch

rysa

nthe

mum

Cin

nam

on

Clove

Co

mfre

y Da

ndeli

on

Fenu

gree

k Fe

nnel

Ging

er

Gree

n te

a Ja

smin

e Le

mon

/ Lim

e Le

mon

gras

s Lic

orice

Ne

ttle

Pepp

erm

int

Sage

Sp

earm

int

OILS

Ol

ive oi

l Co

conu

t oil

SWEE

TENE

RS

Hone

y Pa

lm su

gar

Mol

asse

s OT

HERS

Br

oth

Chick

en

Fish

Soup

STOP

/RED

UCE

VEGE

TABL

ES

Chilli

es

Eggp

lant

Horse

radi

sh

Mus

hroo

ms

Pepp

ers (

Hot)

Popc

orn

Pota

toes

To

mat

o FR

UITS

Or

ange

GR

AINS

Oa

ts Re

fined

item

s BE

ANS

Chick

peas

Sp

lit pe

as

Soy b

eans

To

or da

l DA

IRY

Chee

se

Crea

m

Ice cr

eam

So

ur cr

eam

Yo

ghur

t low

fat

Butte

r NO

N VE

G Eg

gs

Ham

Re

d mea

t

Alka

line

Antio

xida

nt S

hopp

ing

List

N

ame

……

……

……

……

Dat

e …

……

……

Dur

atio

n …

mon

th

NUTS

& SE

EDS

Alm

onds

–so

aked

Br

azil n

uts

Cash

ews

Haze

lnut

s M

acad

amia

Pine

nut

s SW

EETE

NERS

Su

gar

Suga

r sub

stitu

tes

DRIN

KS

Alco

hol

Alm

ond m

ilk

Carb

onat

ed

Choc

olat

e Gr

ape j

uice

Le

mon

ade

Oran

ge ju

ice

Oran

ge pe

el Sh

akes

CO

NDIM

ENTS

Ch

ocol

ate

Chut

ney,

hot

Gher

kins

Gom

asio

Pi

ckles

Vi

nega

r

Page 10: Travel Consultation Case Sheet

Important

1. This is not a balanced diet. You are not absorbing a balanced diet right now. This is a light diet that is designed to rest your digestive system

and optim

ize /your absorption.

2. Once you achieve better digestion, you need to have a NEW

norm

al diet. Diet changes as you and your life change.

4. You need to be under supervision w

hen you follow

this diet. Any concerns should be discussed. This m

eans, periodically you need to contact your practitioner to m

ake sure you are getting all essential nutrients that you need.

5. To obtain maxim

um

results, you need to follow

it strictly.

Shopping •

Find out all the healthy, organic shops and m

arkets near your office and hom

e. •

Have a weekly shopping

day. Shop for grocery item

s for the whole w

eek and perishables for 3-4 days. Have another m

id-w

eek shopping day for perishables.

• Alw

ays buy healthy snacks for the car, kitchen and office, especially if you are ‘snacker’.

• Alw

ays store quick meals

such as organic soups and salads for em

ergency evening m

eals. •

Check your kitchen cupboards and throw

aw

ay all the food items

past expiry date.

Cooking

• Breakfast: Get a good quality juicer. Fresh vegetable juice is good for breakfast. This w

ill optim

ize your energy levels.

• Lunch should have 60%

colored vegetables, 20%

carbohydrates and 20%

from

your ‘favorite healthy’ choice.

• Soups and light salads are the best as dinner especially if it is late. Light dinner includes easily digestible vegetables and soft carbs (eg: cous cous).

• Do not heat / roast / panfry the sam

e meal

twice as it becom

es carcinogenic.

• Steam

ing is the best, boiling is the second best for a healthy life. Get a quality steam

er.

100% Nutrition 1. Reason: Eat when

you are hungry. (If you are not hungry - im

prove your digestion). 2. Eater & the food: Food is appropriate to the eater. 3. Food, chef & the eater: W

holesome

food, happy chef and mindful eating. 4.

Four textures: Have at least 4 textures at least in 1 m

eal daily. 5. Five senses: Engage all senses. W

e get 20% of pleasure

through each

sense. 6.

Six flavors:

Include sweet, salt, sour, bitter, pungent and astringent in a m

eal. A healthy ginger-lem

on pickle has five. How

to get sick 1. Too much acidic

food: (tomatoes, vinegar, yeast...). 2.

Acidic eating:

Not chewing

enough forces our stom

ach secrete more acid. 3.

Acidic lifestyle: Rushing, unplanned life etc. 4. Acidic m

indset: Unresolved issues and negative thoughts about them

. 5. Acidic breathing: Not breathing deep enough.

Health and well being articles

Download more than 12 articles written

by Rama and Caroline published in leading

magazines from

our website.

Ayurveda Elements

Established 1996 17 Orchard Rd Chatswood Sydney 2067

ww

w.ayurvedaelem

ents.com

info@ayurvedaelem

ents.com

02-9904 7754

Page 11: Travel Consultation Case Sheet
Page 12: Travel Consultation Case Sheet

Here is how I am going to do My Ayurvedic health program… It will be planned and systematic.

Program My order Week/day Time

• Herbs Daily As directed

• Shopping Week Day

• Low impact cardio Weekly 1-2-3 times … hours weekly

• Cooking Frequency Time

• Yoga Weekly 1-2-3 times … hours weekly

• Meditation Daily At bedtime

• Cleansing First one Second one

Once they are scheduled,

I know it is easy to do them. Total health is my goal.

…………………………………………………………………………

Here is my signature. And this is my promise to myself.