Ayurveda Questionnaire #1 – Helping Nature Heal

Welcome to your Ayurveda Questionnaire Part A

Name:

Email:

Phone:

How would you describe your body frame and weight?

Thin, irregular, prominent bones, low weight or underweight

Medium, balanced bones; balanced, evenly maintained weight

Large, solid bones, heavy or overweight

Describe your Skin:

Dry, cold, rough, thin and dark, with cold hands and feet

Moist, warm, smooth, oily and rosy, fair with freckles and easily irritated

Soft, cool, damp, thick and pale

How much do you sweat?

Hardly at all

Profusely

Moderately and consistently

What is your hair like?

Dry, thin, dark, curly, knotted and brittle, with split ends

Oily, straight, blonde/red/grey or bold

Oily, lustrous, thick, wavy and brown

What best describes your facial features?

Pointed, irregular nose and long nostrils, with thin, dry and cracked lips

Straight, roman nose, with deep red, moist and soft lips

Large, round nose and wide nostrils, with large, thick lips

How would you describe your bodily features?

Small, slim hips; flat and deficient abdomen; thin legs with knobbly knees

Medium hips; firm and moderate abdomen; medium-sized legs

Large hips; soft, full and large abdomen; strong, large legs

What is your menstrual cycle like (women only)?

Irregular, mild, scanty flow, with clots, intense cramps and dark colour, and a tendency towards PMS and tearfulness

Regular, heavy, long bleed, bright red colour, medium cramps, and bad PMS and irritability

Regular and easy, with dull cramps, water retention, and mild PMS

How would you describe your sleep?

Disturbed. You’re a light sleeper and often suffer from insomnia

Good. Restful and you don’t need much sleep

Deep. You’re a heavy sleeper and you sleep for long periods of

You've been set a team project. What best describes the character or role you would assume in the group?

You’re the creative one, full of wonderful and sometimes radical ideas, but when it comes to meetings you find yourself daydreaming and thinking about what you’re doing at the weekend rather than taking notes

You’ve written the project plan, organized the meetings, prepared immaculate handouts but if your ideas are criticized, you feel infuriated

You’re reliable, you do all the work you need to do, but it takes a lot of time and effort to complete the tasks

You have an exam coming up. Which best describes how you prepare?

You cram in the study at the last minute. You just about remember what you need to for the next day but you’ll forget it all by the next week

You have a meticulous study schedule, you’ve given yourself plenty of time to revise and you remember every detail.

It takes you ages to remember anything, but once you do, you never forget

You’re at a part and someone is flirting outrageously with your partner. How do you react?

You feel insecure and anxious but you probably won’t confront your partner

You turn into the green-eyed monster, the vol-au-vents are flying and you end up having a huge argument.

You know you have nothing to worry about and you carry on having a great night with your friends

Is your appetite…

Variable. You like to graze all day and pick at bits as and when you fancy.

Regular. You like to eat at particular times but when you’re hungry its intense and you can’t focus until you’ve had some food.

Low. You rarely get thirsty

Is your thirst…

Variable. You generally prefer hot drinks

Regular. You’re often thirsty and generally prefer cool drinks

Low. You rarely get thirsty

Would you consider your digestion and bowel movements to be…

Irregular. You’re often bloated, gassy or constipated. You always get constipated when you stay away from home

Regular as clockwork. You have a fast metabolism, evacuate your bowels everyday but can suffer from acidity or hearburn

Sluggish. You have a slow metabolism and sluggish bowels

What do you often suffer from?

Anxiety, insomnia and nervous problems

Inflammation, bleeding problems and skin problems

Mucus, congestion and chest or heart problems

If you get ill, do you…

Get acute symptoms that start all of a sudden and then make a quick recovery

Suffer from fevers and sweating

Take a while to get an illness that then lingers for some time

What is your energy like? Do you…

Have extremes of energy that can be used up very quickly, leaving you exhausted

Have consistent energy and know how to pace yourself.

Take a while to get going but then have excellent stamina

How do you manage your weight?

You find it difficult to gain weight

You have been able to maintain a regular weight throughout your life.

You find it very easy to put on weight

What is your sex life like?

You have erratic sexual appetite but are quickly aroused and have low fertility.

You have passionate sexual appetite and good fertility.

You have a regular appetite, good stamina and excellent fertility.

You’re on holiday, its 30 degrees in the shade. Which of the following best describes you?

You love the heat and are a sun worshipper. You go brown really easily

You find the heat unbearable, you feel agitated and all you want to do is stay in the pool. You can burn easily and get prickly heat rashes

You don’t mind the heat but prefer to take it easy and relax all day in the shade

I tend to feel blocked in my body (constipated, congested in the head, general lack of clarity, or other).

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In the morning when I wake up, I'm groggy; it takes me quite a while to feel really awake

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I tend to feel weak, physically, for no reason that I can see.

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I get colds (or similar conditions) several times each year

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My body tends to have a feeling of heaviness

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I just tend to feel that "something isn't working right" in the body (digestion, breathing, bowel movements, or something else).

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I tend to feel lazy. (My capacity to work seems all right, but I have no inclination.

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I commonly have indigestion

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I often have to spit

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Often, I just don't have a taste for food. I have no appetite

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I just tend to feel tired, even exhausted in mind or body

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Time is Up!