Ayurvedic Constitutional Assessment

Name (Optional): Sex:

 
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    		• Please select the entries which describe you best.
  •  
    		• Ignore any questions which do not seem pertinent to you. (The questionnaire must be very detailed to provide an accurate picture of your Ayurvedic constitution. Inevitably this means that some questions will not apply to all people.)
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    		• In some cases you may wish to select multiple entries. To do this you may need to hold down a key whilst clicking (eg Ctrl). This button will also be needed if you need to deselect an option.
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    		• You may submit a partially completed form and still receive an indication of your Ayurvedic constitution. Responding to all of the questions will lead to the most accurate results.

    General

    Age Habits Present Habitat
    Worst
    season    		 Job

    Mind/Psychological

    Echoing
    (persistent)
    emotions    		 Beliefs
    Dreams Moods
    Fear Financial
    Intellect Lifestyle
    Memory
    Thinking
    Mind out
    of balance
    Mind in
    balance

    Physique

    Size Height Weight
    Weight
    change    		 Bones Shoulders
    Muscles Joints

    Head and Face

    Face Complexion Cheeks
    Eyebrows Forehead Chin
    Neck Skin
    color    		 Hair
    color
    Nose Mouth Lip
    color
    Teeth Gums
    Hair Skin
    Lips

    Eyes

    Eye
    size    		 Eye
    focus
    Iris
    color    		 Iris
    size
    Eye
    lashes    		 Conjunctiva
    (eyeball
    membrane)
    Eye
    light

    Tongue

    Color Movement
    Midline
    (spine)    		 Width

    Hands and Feet

    Hands Fingers/Toes
    Nails Nail lunula
    (half-moon shape
    at base)
    Nail color

    Physiological

    Aggravation
    time    		 Aggravation
    season
    Aggravation
    factors    		 Sleep
    Activity Endurance
    Voice Immunity
    Speech
    Disease
    tendency
    Reaction to
    treatment

    Mala

    Stool
    amount    		 Stool
    color
    Stool
    consistency    		 Urine
    amount
    Urine
    color    		 Sweat

    Digestion

    Digestion Appetite
    Taste Thirst

    Women’s

    PMS
    Cycle
    duration    		 Period
    duration    		 Menstrual
    flow

    Sexuality

    Fertility Arousal Sexual
    energy
     
    CGI scripting by Newton Bailey