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Reference
General Information
Name (In Capital letters)
Date of Birth
Age
Marital Status
Gender

Residential Address
Phone(R)
Phone(O)
Mobile

E-mail ID
Suitable Time to Contact
Profession

Health Issues
Any PAST Illness, If yes Please Mention
Any PRESENT Illness, If yes Please Mention

Any History Of illness in The Family (HEREDITARY), If Yes Please Mention
Weight(In Kg At Present)
Height(In Inches At Present)
Waist(In Inches At Present)
Thigh(In Inches At Present)

Life Style

General Food Habbit (Veg/Non-Veg/Tea/Coffee/Smoking/Drinks/Gutkha/Sweets)
Favourite Food
Hobbies/General Habbits

Rising Time
Sleeping Time
Stool Time & Type

How do you spend your Time
What is the Philosophy of your Life
Have you ever joined Yoga Program, if YES Where?
How did you know About Us
Purpose Of Joining Yoga Programme

Any Other Information

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