NAME

AGE

MOBILE NUMBER

EMAIL

BODY FRAME
A : ThinB : moderateC : Thick

BODY WEIGHT
A : lightB : moderate weightC : Large, gains weight easily

SKIN TEXTURE
A : dry, rough or cracked; prominent veinsB : smooth, warm, rosy; freckles; slightly oilyC : pale; moist; soft; oily

HAIR QUALITY
A : coarse, dry; split endsB : fine, soft; can go grey or bald earlyC : abundant, oily, thick, lustrous

JOINTS
A : cold, crackingB : moderateC : Large, lubricated

APPETITE
A : Irregular, variableB : strong, unbearableC : Slow but steady

DIGESTION
A : variable or weak; often has allergies; forms gasB : Strong, able to digest almost anythingC : medium or slow but steady, Forms mucous

NAILS
A : dry, fissured, brittle, break easilyB : pink, LustrousC : thick, oily, smooth

ELIMINATION
A : Dry, hard, constipatedB : soft, oily, looseC : thick, oily, smooth

PHYSICAL ACTIVITY
A : HyperactiveB : ModerateC : Sedentary

SLEEP
A : Light, tends towards insomnia, restlessnessB : moderate, but soundC : Deep, prolonged – not a morning person

MOST COMMON FOOD CRAVINGS
A : dry, sweet, salty – crispy snack foodsB : spicy, salty, hotC : Sweet, creamy, cold

EATING HABITS
A : binges, snacks, forgets to eatB : likes regular, plentiful meals on timeC : eats constantly, overeats regularly

FOOD SENSITIVITIES
A : Beans, cabbage familyB : onions, tomatoes, fried foodsC : Dairy, salt

SWEAT & BODY ODOUR
A : little sweat, no odorB : profuse sweating, strong odorC : moderate sweating, moderate odor

DISORDERS
A : pain, insomnia, mental disorders, ArthritisB : Fevers, ulcers, infections, inflammatory diseases, heart attacksC : respiratory system diseases, mucus accumulation

SPEECH HABITS
A : quick, talkativeB : argumentative, convincingC : not talkative, concise, slow

MENTAL NATURE
A : quick, adaptable, indecisive, impulsiveB : factual, penetrating, criticalC : slow, steady

EMOTIONAL RESPONSE TO CONFLICT
A : quick, but soon overB : hot, irritated or defensive; holds grudgesC : slow, but lingers for a long time

SPENDING HABITS
A : spends easilyB : spends for a purposeC : spends with difficulty