Ayurvedic Constitutional Assessment Form

Ayurvedic Constitutional Evaluation Questionnaire

According to Ayurveda, the key to health is in understanding our own personal body type. There are three basic constitutional types, “doshas” in Sanskrit: Vata (or V), the “air” type. Pitta (or P), the “fire” and Kapha (or K), the “water” type. Each of us has some of the characteristics of all three of these. Many of us are dominant in more than one dosha. In general, Vata people are sensitive and cheerful, quick to adapt to any new situation with enthusiasm. They crave excitement and stimulation, and are often the life of the party. They are quick in thought and in movement, seem to walk a little above the ground, and can be everywhere at once. They may be spacey, lacking in concentration skills, and may not have staying power in projects they begin with zeal. Their energy level is erratic. Physically, are slight and slender. Under stress, they tend towards anxiousness and worry.

Pitta people are bright and brilliant, intense and intelligent. They are very practical, doing what needs to be done with focus and determination. They tend to be ambitious and goal oriented, succeeding through sheer force of will. They are fair minded and logical, and can think through any problem step by step. They are forceful in their relationships, and communicate with directness. They tend to be organized, and their lifestyles are well paced and thought out. Physically, they are of moderate build, and usually have bright, intense eyes. Under stress, they tend towards frustration and anger.

Kapha people are loving, compassionate, and caring, often choosing lives of service. They have calm, patient, and stable personalities, and happily follow a regular routine. They enjoy the peace of home, and cultivate life’s comforts and pleasures. However, they have an innate strength, and work very hard at whatever is truly important to them in a stable and consistent way. They tend to be cautious, committing themselves only after deliberation, but once they have committed they devote themselves entirely. They tend to avoid change, preferring instead the predictable. They tend to move slowly, and conserve their energy. Physically, they are strong and stout. Under stress, they tend towards lethargy, and may have grief or attachment.

When doshas become aggravated, illness results. Each dosha has certain types of illnesses associated with it, for example, ulcers are a common Pitta concern. Also, each dosha has its own unique approach to management, suh as personalized diet and lifestyle recommendations. Knowing what our body type is, therefore, the first step toward understanding what behaviors and therapies are correct for us.

This evaluation questionnaire can help to determine your body type according to Ayurvedic principles. This assessment & evaluation form will guide your therapist to choose the oils and/or herbs that are the most calming and balancing for you. If you do not wish to answer this questionnaire, the therapist will choose oils and/or herbs based on their observations.

********************************************************************************   Please Copy & Paste the form into a WORD Doc Complete & print off. Please Answer the questions as accurately as possible by marking (X) by the side of the answers that apply to you. Bring the completed form with you to your appointment.

1. Body frame, bone structure:

(V) Slight, thin, delicate
(P) Moderate, medium sized
(K) Broad, strong, heavy

2. Body weight:

(V) Light, lean, erratic weight, or difficult to gain
(P) Moderate weight, strong metabolism
(K) Extra pounds, must work hard to lose weight

3. Skin:

(V) Naturally dark; tans easily
(P) Light, pinkish, fair, yellowish, or freckled
(K) Even tones, with a rich, smooth, or milky quality

4. Skin type:

(V) Dry, rough, uneven or combination skin, chapped, cold
(P) Sensitive, burns easily, red patches, or moles, oily
(K) Thick, soft, moist, cool

5. Hair:

(V) Dry, rough, tends to break, curly, frizzy
(P) Light colored, red, early gray; thinning or fine
(K) Thick, lustrous, oily

6. Eyes:

(V) Small, dark colored; flitting gaze
(P) Medium sized, light or pale colored; “fiery” or sharp, penetrating gaze
(K) Large, rich blue or brown; watery gaze

7. Temperature preference:

(V) Cold, loves warmth
(P) Easily overheated, prefer cool climates
(K) Not disturbed by cold or heat, but prefer warm weather

8. Appetite:

(V) Variable, irregular, eyes bigger than stomach
(P) Good, regular appetite; irritable or heartburn when overly hungry
(K) Hearty appetite, may emotionally overeat

9. Digestion and evacuation: (Bowel Movements)

(V) Variable, irregular; constipation
(P) Regular to fast; burning sensations in the digestive tract
(K) Regular, slow

10. Physical aactivity level

(V) Very active, extreme ups and downs, restless
(P) Moderate, even, focused, well paced
(K) Lethargic, hard to get going; good endurance

11. Sleep:

(V) Restless, short, variable
(P) Moderate, sound
(K) Heavy, sound

12. Mental disposition:

(V) Restless, active, creative
(P) Focused, aggressive, intelligent
(K) Calm, stoic; good long term memory

13. General disposition:

(V) Cheerful, adaptive, spacey, changeable
(P) Clearheaded, practical, logical, asserted
(K) Calm, patient, serious, passive

14. Emotional disposition (your dominant negative emotions):

(V) Fearful, insecure, anxious
(P) Frustrated, irritable, jealous
(K) Attachment, grief

15. Speech style:

(V) Fast, variable tones; jumps from idea to idea; talks a lot
(P) Focused; even or impatient tones; concise, logical; talks moderately
(K) Slow, monotones, talks little

16. Movement style:

(V) Quick, walks on air, everywhere at once
(P) Well paced, direct, moves from point A to B
(K) Slower, moves as little as possible, flowing movement

Number of Vata:
Number of Pitta:
Number of Kapha:                                                                                                                                                  Julie Kelly.                                                                                                                                                                                  Professional Stress Consultant & Eastern Ayurvedic Massage Therapist.                                         173 Mitchell Hey Rochdale UK OL12 6UN