First Name
Last Name
Date of birth
Phone
*
Email
*
Which body type best dexcribes you?
Slim
Moderate
Heavy
How easily do you gain weight?
Nearly impossible
Moderately
Too easily
What best describes your overall body state?
Thin, dry, or prone to cold
Warm, moderate build, or prone to overheating
Heavy, solid build, or prone to cold/damp
How do you feel emotionally most of the time?
Anxious, worried, or restless
Irritable, impatient, or angry
Lethargic, unmotivated, or melancholy
How is your digestion currently?
Irregular appetite or bloating
Heartburn, acidity, or strong hunger
Sluggish digestion or heaviness after meals
What is your hair like?
Dry, frizzy, prone to split ends and breakage
Fine, oily, tendency toward thinning or graying
Thick, abundant, more on the oily side
What are your joints like?
Prominent, tend to crack, often aching, injury-prone
Flexible, agile
Large, well padded
How would you describe your energy levels?
Low stamina, energy fluctuates often
High energy but prone to burnout
Persistent fatigue and heaviness
What is your temperament like?
Enthusiastic, vivacious, creative
Driven, passionate, ambitious
Easy-going, giving, patient
What describes your current sleep patterns?
Difficulty falling or staying asleep
Overheated, wake up often at night
Sleep too much but still feel tired
How is your skin right now?
Dry, rough, or flaky
Red, inflamed, or sensitive
Oily, congested, or prone to acne
How are your bowel movements?
Hard, dry, or constipated
Loose, urgent, or frequent
Slow, heavy, or sticky