Online Form

Open Online Form

Printable Forms

Print, fill out, and fax each form to 503-217-6046 at least 48 hours prior to your appointment

  1. Consent Form
  2. Lifestyle History
  3. Ayurvedic History
  4. Medications/Supplements

Or print, fill out, and bring each form above with you to your appointment if you lack sufficient time to fax.

Clinical Ayurvedic Specialist

Dhyana Haber

Golden Lotus Ayurveda

3609 SW Corbett Ave.
Portland, OR 97239
503-248-4670