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Ayurveda
Ayurveda Initial Assessment
Body Type
Digestion Assessment
General Health Survey
For Women Only
Emotional Body Map
Addiction Questionnaire
Aromatherapy
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Field Notes
First name
Last name
Digestion Assessment
Is your hunger:
irregular, varies from meal to meal
generally strong, cannot skip meals
mild, can generally easily skip meals
After eating, speed of digestion (time it takes to feel hungry again) is:
irregular, varies from meal to meal
quick, I feel hungry again after a few hours
slow, I'm not hungry again for 5-6 hours
Food capacity (amount you can eat at a time)
varies from meal to meal
large as compared to most other people
small, as compared to most other people
Fluctuations of body weight
Easy to lose, difficult to gain; I tend to be underweight.
Can maintain normal weight even with fairly large food intake.
I gain weight easily, even with moderate food intake. Difficult to lose weight.
Energy level:
Variable or low compared to others
Abundant compared to others
Good, but may tend toward laziness
Regularity of bowel movements
Irregular, tending toward constipation
Frequent; often more than 1-2 times a day
Regular, once or twice daily
Quality of stool:
Hard, dry
Loose
Well-formed
Digestive symptoms
Gas or bloating
Frequent belching
Constipation
Intestinal cramping or discomfort
Acid reflux
Heartburn
Diarrhea tendency
Sluggish digestion (regular, not variable)
Heaviness or sleepy after eating (often)
Stool sticky or with mucus
Date
Day
Month
Month
Year
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