Dear Guest,

Namaskar!

Welcome to your transformative journey at Dharana.

There is an inherent need for a racing mind to feel steadiness and a quiet strength that holds it together for an overall peace of mind. Dharana refers to the 6th stage of Patanjali yoga sutra – a Yogic path, which entails forgetting oneself in the object of his or her meditation. It is a state of feeling relaxed and at ease, which in turn allows for deeper forms of contemplation and meditation.

The Dharana way of life aims to help you achieve long-term internal and external wellbeing through personalised programmes. The idea is to help you develop lifestyle disciplines that balance the energies and points to calmness and contentedness.

To help us design your personalised wellness programme, our wellness consultants would like to know more about you. Please find attached, the two questionnaires and the retreat guidelines

  • Dharana Wellness and Prakruthi information. (Approximate time to fill 20 minutes)
  • Retreat Experience. (Approximate time to fill 10 mins)

Feel free to call or e-mail us in case of any questions.

We look forward to seeing you.



Warm Regards

Dr. Arun Pillai

Director of Spa & Wellness

Questionnaire 1

Part a. Dharana General Wellness Questionnaire

Personal Information

Name of wellness programme enrolled in: (Choose one)

Key reason for your visit: (Choose one or multiple)

Knowing Your Health Better

Vital Signs

These will be checked at the Dharana wellness centre. Feel free to leave this section blank

Anthropometrics

Has your weight changed in the last 6 months -1 year period?

kgs
kgs

What is your general state of health? Please specify any specific weak areas that you would like to work on.

Do you suffer from any specific illness like cancer, diabetes, hepatitis, others? If yes, what has been the duration of the illness?

Have you had any major or minor surgeries? Please specify approximate time period?

Lifestyle Information

Choose one of the sleep patterns most suitable to your routine.

Musculo-Skeletal System

Do you suffer from any of the below:

Circulatory System

Do you suffer from any of the below ailments?

Gynaecological History

Do you suffer from any of the below?

Nervous System

Have you previously suffered or are suffering from any of these ailments?

Digestive System

How would you rate your appetite? Choose one.

How would you rate your digestion and bowel movements? Choose one.

Do you suffer from any of the below?

Immune System

Are you prone to any of the below conditions? Is yes, how frequently?

Others

Diet Information

In a week, how many times do you eat the below. Please specify a number.

Non Veg other than fish
Coffee / Tea
Fish
Ice Cream
Egg
Milk Shakes
Pizza / Burger
Chocolates
Biscuits
Type of oil
Sweets / Desserts
Fried foods
Milk
Pickle
Jam/ Sauces
Leafy Vegetables
Yogurt (curd)
Fresh Fruits
Instant Foods
Dry Fruits
Soft drinks
Cereals
Cottage Cheese (paneer)
Pulses
Sugar (please specify number of tea spoons)
Water (per day)

Thank you for completing the first part of the questionnaire. Let’s move onto the next step of knowing your prakruthi (body type) better.

Part b. Ayurveda Prakruthi Questionnaire

Please check one statement that best describes you. Occasionally, there may be two statements that are most suited.

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