Ayurvedic Intake Form
Please download, print, and fill out this form before your first visit so that we can go over it in entirety. When filling out the form make sure to answer the questions for your current condition and imbalances. It should take about 1/2 hour.
| ayurvedic_intake_form-3.pdf |
Dosha Quiz*
Click HERE to take a free Dosha Quiz to learn your unique Prakriti - Vata, Pitta, Kapha.
"Prakriti" is your basic constitution. It is determined at the moment of conception and relates to your genetically inherited
physical and emotional qualities.
Prakriti specifically relates to those qualities, characteristics and tendencies that are stable. For instance, while you may experience temporary changes, like gaining or losing ten pounds, feeling nervous or irritable, developing a cold or flu, etc., in the natural course of life you will never gain or lose five inches on your height or experience a change of eye color.
Prakriti is enlivened and described by three main doshas or forces: Vata, Pitta and Kapha. These are loosely translated as Air, Fire and Earth, respectively. Each of us has all three doshas in our constitution, in unique proportions. In Ayurveda, seven dosha-predominant Prakritis are described: Vata-predominant, Pitta-predominant, Kapha-predominant; three dual Prakritis, where two doshas are equally, or nearly equally predominant: Vata-Pitta predominant, Pitta-Kapha predominant and Vata-Kapha predominant; and one Prakriti that has all three doshas equally prominent: Vata-Pitta-Kapha
predominant.
It is useful to know your own inherent physical and emotional tendencies in order to learn how to keep them balanced and
maintain heath.
*When filling out the Quiz look as far back into your childhood as you can remember to identify the aspects of your nature that have remained consistent.
"Prakriti" is your basic constitution. It is determined at the moment of conception and relates to your genetically inherited
physical and emotional qualities.
Prakriti specifically relates to those qualities, characteristics and tendencies that are stable. For instance, while you may experience temporary changes, like gaining or losing ten pounds, feeling nervous or irritable, developing a cold or flu, etc., in the natural course of life you will never gain or lose five inches on your height or experience a change of eye color.
Prakriti is enlivened and described by three main doshas or forces: Vata, Pitta and Kapha. These are loosely translated as Air, Fire and Earth, respectively. Each of us has all three doshas in our constitution, in unique proportions. In Ayurveda, seven dosha-predominant Prakritis are described: Vata-predominant, Pitta-predominant, Kapha-predominant; three dual Prakritis, where two doshas are equally, or nearly equally predominant: Vata-Pitta predominant, Pitta-Kapha predominant and Vata-Kapha predominant; and one Prakriti that has all three doshas equally prominent: Vata-Pitta-Kapha
predominant.
It is useful to know your own inherent physical and emotional tendencies in order to learn how to keep them balanced and
maintain heath.
*When filling out the Quiz look as far back into your childhood as you can remember to identify the aspects of your nature that have remained consistent.
