In ordinary cases, Correspondence treatment is given. Questionnaire is supplied by 'Yog Vidyapeeth' to be replied by patient. One time donation expected from the financially sound patients Rs. 1000/- or more (for people outside India this amount is US $ 10 or more) to be paid through money order (international money order from outside India) in favour of 'Dr S K Kaura' (who is the international coordinator of Yog Vidyapeeth) or through bank cheque in favour of 'Dr S K Kaura' at the following address: Yog Vidyapeeth, 10-C Firends Colony, Hisar-125001, India.
For out station cheques a clearing charge of Rs 70 should be added to the amount sent.
Financial incpable patients/students/unemployed persons/persons from underdeveloped countries/persons affected by natural calamity/handicaped persons may be given concession ranging from 10 to 100% depending on the All letters/phone calls/emails are replied during this period.
The format of Questionnaire is given bellow, which can be downloaded by the patient and sent to [email protected] or through post
In case you find any problem in filling the details please contact
your family doctor for proper identfication and diagnosis of the problem you are facing. Please attach the photostat copies of all the medical reports,
laboratory reports, body scans, etc. Please use separate paper for if the space given here is insufficient.
Consultation Performa for Treatment by Correspondence
Details about yoga practice
1. Are you practicing yoga and pranayama? If yes for how long: _________________________________________________________________________
_________________________________________________________________________
2. Did you face any problem while doing yoga? Any bad effect on health : ____________________________________________________
3. From which institution or Guru have you learnt yoga and pranayama? __________________________________________________
4. Do you wish to learn more about yoga? _______________________________________________________________________________________________________________________
5. What benefit have you experienced while doing yoga, pranayama and meditation? _______________________________________________________________________________________________________________________
6. Write your problem in detail, history, what trigerred the problem. Also mention the treatment you have already taken
3. Age & Education: _______________________________________________________
4. Height & Weight:
At present Before Disease
Height: _____________ Height: _____________
Weight: _____________ Weight: _____________
5. Married or unmarried: ____________________________________________________
6. Occupation - Its duty hours? How spent - Sitting Deskwork or Movement field work?
___________________________________________________________________________
7. Period of rest, sleeping time at night and rising time in the morning. Quality of sleep -
deep or disturbed: ____________________________________________________________
8. What and how much do you eat; at what time do you eat? ______________________
___________________________________________________________________________
9. Number of times bowels are cleared? Type - Solid or loose? ____________________
10. Do you suffer from constipation? Are there itching, boils, rashes on the body? ___________________________________________________________________________
11.Taste of mouth, colour of tounge: __________________________________________ __________________________________________________________________________
12. Any addiction - Biri, Cigarette, Tobacco, sniffing/orally, Ganja, Opium, alcohol, Betel- leaves, Betelnuts, Smack/hashis etc.: ___________ ___________________________________________________________________________
13. Mental status - worries free or worry some: _________________________ ___________________________________________________________________________
14. History of the case from beginning: ______________________________________
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
15. Diagnosis by Doctors: _______________________________________________
_________________________________________________________________________
_________________________________________________________________________
16. Is illness permanent or intermittent? _________________________________ ___________
17. Present symptoms of diseases: _______________________________________ __________
18. Hereditary disease in your family: _________________________________ _____________
19. If fever - when and how much: ________________________________ _________________
20. Eye sight - week or strong; spectacles used, its power: ____________________________
22. Do you perform Worship, prayer or meditation: ____________ _______________________
23. Have you gone through nature-cure; name the books: ____________________
__________________________________________________________________________
24. If taken nature-cure treatment - its description: ___________________________
___________________________________________________________________________
25. Seasonal fruits/vegetables of your place: _________________________ ___________________
26. Temperature of town/place: _________________________________ __________________________________________________________________________
27. Any other special mention: _____________________________________________________ __________________________________________________________________________
For Ladies use only
1. Menstruation�s - timely or untimely - duration; Any unnaturality: _________________________________________________________________________
_________________________________________________________________________
2. Have suffered from leukorrhoea: ____________________________ ________________________
3. Has or how has it been treated? _________________________ _________________________
Space for special details______________________________________________ _________________________________________________________________________
I am enclosing a recent coloured photograph (close up) along with the performa.
I am enclosing/sending a bank cheque/money order for Rs 1000/US $ 10 or more specify _______ along with the performa as a donation to Yog Vidyapeeth
I understand that the treatment offered to me by Yog Vidyapeeth is not a medical treatment but is infact spiritual and lifestyle advice based on traditional knowledge, yoga and naturopathy.
I undertake this health advice on my own judgement and risk and will not hold responsible Yoga Vidyapeeth (PROPOSED OPEN YOGA UNIVERSITY) or any of its associated or its associated individuals/institutions/experts/employee/volunteer for any problem arising out of the health/spiritual advice got from Yoga Vidyapeeth (PROPOSED OPEN YOGA UNIVERSITY) or its associated individuals/institutions.
Name of the applicant:________________________
Signature of the applicant (Signature of the
parent/guradian in case the applicant is a minor):________________________
Place:________________________
Date:________________________
Click Here to Sign the Guestbook of Yog Vidyapeeth to pen in your suggestions, product and service requirements, complaints, experiences with yoga and naturopathy treatment.
Click Here to See Guestbook of Yog Vidyapeeth and discover what others have to say.
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Yog Vidyapeeth (Proposed Open University of Yoga) is a non-profit voluntary organisation run by the foundation called 'Innovative India'.
Your financial contribution is solicited to provide free health support to millions of people all around the world.
All contributions should be sent in favour of 'Dr S K Kaura' (who is the international coordinator of Yog Vidyapeeth) through money order or through bank cheque in favour at the following address: Yog Vidyapeeth (Proposed Open University of Yoga), 10-C Firends Colony, Hisar-125001, India. Foreign conrtibutors may discuss about preferred mode of donation (payment through credit card and similar means is also encouraged and can be discussed through email at [email protected]).
The amount would sent through cheque or other means in favour Yog Vidyapeeeth (Proposed Open University of Yoga) would not be be available to the Yog Vidyapeeeth (Proposed Open University of Yoga) as till date the institution has not active bank account.
Email: [email protected]
Web site: www.geocities.com/nf_net/sryv
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