Newlife Registration Form


Date
Father/Husband Name:
Enter Address:             
E-Mail Address
Phone Number
Occupation :    
Emergency No:
PAN CARD:     
Adhaar Card:    

Detox programs Previously attended:

Newlife :
Ph :         
TTT :       

I. Any Family History of

High Blood Pressure :
Heart Diseases :
Diabetes :
Thyroid :
Cancer :
Lung Ailments :
Anaemia :
Epilepsy :
Neurological Issues :
Allergies :
Others :    

II.Your Past Medical History :

Others :    

III.Your Present Medical History :

NEUROLOGICAL :
Others :    
GASTROINTESTINAL :
Others :    
ENT :
Others :    
GENITO-URINARY :
Others :    
CARDIOVASCULAR :
Others :    
MUSCLE-SKELETAL :
Others :    
HEMATOPOIETIC :
Others :    
SKIN :
Others :    
GENERAL :
Others :    
VITAMIN DEFICIENCIES :
Any Deficiency :    
AUTOIMMUNE DISEASES :
others :    
MENSTRUAL HISTORY (for Women) :
Children-no. of children :    
Abortion - Cause :    

IV. ALLERGIES :

Drugs :    
Food :      
Others:    

V. LIFESTYLE HABITS :

CIGARETTES/TOBACCO :
ALCOHOL :
TEA/COFFEE :
LATE NIGHT SLEEP :


EXERCISE :

VI. ARE YOU UNDER MEDICATION AND FOR :

Allopathy :      
Homeopathy :
Ayurveda :      
General Disclaimer and Limitation of Liability

Guests agree that all treatments, services and facilities at THE CURING TREE are requested and used at the Guests’ own risk and that they will have no recourse against THE CURING TREE, and its shareholders, directors, affiliates, representatives, staff and suppliers, for any alleged damage or loss arising out of or in connection with the spa treatments, services and/or facilities. The TCT Centre‘s website does not represent or endorse the accuracy, completeness or reliability of any advice, opinion, statement, or other information displayed, uploaded, or distributed through the website. You acknowledge that any reliance upon any such opinion, advice, statement, or information shall be at your sole risk.

Your Medical Disclaimer:

I understand that who provides me with education, and information on the holistic approach to healthcare, which may affect my diet, lifestyle and health in a positive way, Does not seek to diagnose, treat or prescribe for diseases, disorders or other pathological conditions. I agree that I am interested in enhancing my own abilities to regain balance and establish health in mind and body, and this is the reason I have sought that services. I agree that I may consult a licensed physician for any concern, at any time, about any disease or pathology, which now exists or arises at any time during my professional relationship with TCT. I also understand that only a licensed physician of my choice can advise on medication dosages or the discontinuance or resumption of allopathic medication.

TCT is a Ayurvedic/Naturopathy/Holistic /alternative wellness center designed to be informative, educative and supportive of establishing a balance of health within body-mind-spirit, through maintenance of health and prevention of imbalances. . None of the information, treatments or products are intended to diagnose, treat, cure or prevent any disease. If you wish for medical concerns or before making changes to your diet or lifestyle, please consult your physician.

Please DO NOT take TCT as a means to substitute your medical treatment. Ayurveda/Alternative /naturopathy Therapy is a long term, slow acting therapy that includes diet, lifestyle changes along with stress management with Ayurvedic bodywork, yoga and meditation practices. It is the therapy that slowly builds immunity introducing healthy habits for strengthening and improvement of health and helps preventing risk of imbalances into chronic diseases. It is not an substitute plan for Chronic diseases.

Feedback & Opinions:

Any feedback/opinion(s) expressed in response to e-mail queries shall not be treated as medical advice. Until and unless the physical examination of the patient is carried out, no treatment shall be initiated. E-mail transmission cannot be guaranteed to be secure or error-free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which arise as a result of e-mail transmission. Whilst every effort is made to address all queries and to accommodate valuable feedback from the users, TCT Centre does not guarantee a response or action to every mail.

 I agree to the terms and conditions