First Name *

First Name

Last Name

Age *

1 - 20

20 - 65

65 <

Aging *

Taller or shorter from average

Looking my age

Ageing fast, looking older

Height *

Short and Sturdy

Medium

Taller or shorter from average

Weight *

Hard to lose

Losing and gaining easily

Difficult to gain

Where do you gain weight *

Arms

Midriff

Hips

How is your body frame? *

Broad shoulders and chest

Equal hip and waist

Wide hips, narrow shoulders

How are your joints? *

Large

Medium size, reddish

Prominent, dry

Physical Strength *

Strong stamina, likes endurance

Strong, likes high intensity

Tires quickly, likes low intensity

Skin *

Oily, tight, smooth, whiteheads, no wrinkles,

Soft, lustrous, hormonal cysts, red, tends to wrinkles, freckles

Dry and light, papery, blackheads

Skin temperature *

Cold and damp

Warm

Cold and dry

Hair *

Thick and wavy

Fine and soft, fair or red

Dry, coarse, curly, very thin or very thick

Shape of your face *

Large, rounded

Heart shape, oval

Sharp features, angular, asymmetric

Nails *

Smooth, large, shining, white

Soft, medium, pink

Rough, brittle, small

Nose *

Large and rounded

Neat, pointed

Asymmetric, bony, small or large, narrow

Eyes *

Large, prominent whites, blue, light brown, black

Average, light blue, green, sharp, steady gaze

Small, narrow, dark brown, grey, move a lot

Teeth *

Big, white strong, even, healthy gums

Medium, small even, yellowish, gums bleed easily

Uneven, greyish, sensitive, thin gums

Tongue *

Large, pale, white coating, pastry edge

Medium, reddish

Thin, moving, pointed, leans on one side

Digestion *

Gas, irregular digestion, sensitive stomach

Strong and steady digestion

Slow, heavy, feel sleepy after eating

Sweat *

Moderate

Profuse, strong odour

Minimal

Stools *

Slow, plenty, sinks, mucus, brown

Regular, soft snake like or loose, yellowish, smelly

Irregular, tend to constipation, dry, dark, small

Appetite *

Steady appetite, eats even if not hungry, comfort eating

Good appetite, can eat large portions, needs to eat regularly

Irregular, small appetite, forgets to eat

Sleep *

Deep, long

Sound, short

Light, disturbed

Tendency of ilnesses *

Congestions sinus or chest. mucous, colds, fluid retention, allergies, obesity, diabetes, fibroids, cysts, high cholesterol

Acidity, heartburn, indigestion, inflammations, skin disorders, migraines, headaches, fever,

Dyhydration, constipation, anxiety, lower back pain, sciatica, asthma, insomnia, haemorrhoids, palpitations

Nature of speech *

Mindful, slow, soft

Sharp, clear, precise

Fast, excited

Environmental preferences *

Loves dry & warm, avoids damp

Prefers cool, shade, sensitive to heat

Prefers warm, dislikes wind

Positive Emotions *

Compassionate and motherly

Content and decisive

Excited and inspired

Negative Emotions *

Isolation, depression, stubbornness, possessiveness

Irritable, aggressive, intense and manic

Fearful, anxious, panicky, volatile

Memory and concentration *

Good long term memory, takes time to learn

Good, quick

Poor long term, learns quick, forgets quick

Routine *

Good regular routine, untidy

Long working day, organised, logical, loves lists

Irregular routine, disorganised