AYURVEDIC PRAKRUTI PROFILE
(Determining your body type)
Full Name _________________________________
Date _____________________
Age _________ Sex: M F
NOTE: It is desirable to have not eaten or had any caffeinated drink two hours
prior to the consult. This enables accurate reading of the pulse.
Please read carefully before filling out the questionnaire:
1. This intake form will help me determine your norm or normal. This form is NOT
meant for reporting your abnormal or imbalances. I will ask about your symptoms
and complaints at the time of the consult.
2. Here are a couple examples how you can select the correct choice:
a. Your energy levels might be low today due to age or illness, but you tend to be
a high energy person when you are well. Then you will choose high energy in
your selection.
b. OR maybe you were not constipated in your early life, but now you are. So you
will NOT choose constipation in your selection, as that is NOT your norm, it is an
imbalance.
3. In some questions, you may find that more than one choice applies to you. You
should go ahead and check or underline ALL that apply.
1) Which best describes your BUILD?
a) I'm small-boned with a thin build.
b) I have a medium build and a fairly well balanced body.
c) I have a solid, ample, or stocky build with larger bone structure.
2) Which answer best applies to you? WEIGHT
a) My weight is below average for my build.
b) My weight is average for my build.
c) My weight is above average for my build.
3) Which answer best applies to you? WEIGHT GAIN
a) I tend to lose weight easily. It is relatively hard for me to put on weight.
b) I maintain my weight easily.
c) I gain weight easily and find it hard to lose.
4) Which answer best applies to you? STRENGTH AND STAMINA
a) I get worn out easily.
b) I am fairly strong and can handle various physical activities.
c) I have good stamina and a steady energy level.
5) Which answer best applies to you? PHYSICAL ACTIVITIES
a) I like to be active, “on the go”; it’s sometimes hard to sit still.
b) I enjoy physical activities with a purpose, especially competitive ones.
c) I like leisurely activities best.
6) Which best describes your APPETITE?
a) My appetite is irregular, sometimes I'm hungry, and sometimes I'm not.
b) I have a large appetite and digest food quickly. I may be irritable if I miss a meal.
c) Not a big eater; I like to eat, but can skip meals easily.
7) Which answer best applies to you? DIGESTION
a) I tend to eat quickly; I have a delicate digestion.
b) I have a strong digestion; I can eat almost anything.
c) I eat and digest slowly; sluggish digestion
8) Which best describes your THIRST?
a) Less, but might vary.
b) Frequent and intense.
c) Less.
9) Which best describes your TASTE PREFERENCE?
a) Sweet, salty, heavy, oily.
b) Sweet, light, warm, bitter.
c) Dry, low fat, sweet, spicy.
10) Which best describes you? FOOD TEMPERATURE
a) I prefer warm food and drink to cold.
b) I prefer cold food and drinks.
c) I prefer hot food and drinks.
11) Which best describes your BOWEL MOVEMENTS?
a) Irregular, hard, dry; tends towards constipation.
b) Easy, regular to frequent movement, tends towards loose or diarrhea.
c) Regular to less frequent, normal consistency, oily.
12) Which best describes your URINE?
a) Clear, scanty, frequent, thin in consistency, can be frothy sometimes,
b) Abundant, yellow, red, burning.
c) Moderate, whitish, thick in consistency
13) Which best describes your PERSPIRATION?
a) Scanty, no odor.
b) Profuse, strong odor.
c) Moderate, cold, pleasant odor.
14) Which answer best applies to you? SLEEP
a) I have difficulty falling or staying asleep.
b) I sleep well, but for an average length of time.
c) I generally sleep long and soundly, and have difficulty waking up.
15) My DREAMS usually consist of:
a) Flying, running, fear, nightmares.
b) Anger, violence, sun, passionate.
c) Romantic, water, ocean, sentimental.
16) Which answer best applies to you? WALK
a) I walk quickly, more quickly than others, with quick short steps.
b) I have a determined purposeful walk.
c) My walk is slow, stable and graceful, at a more leisurely pace.
17) My LEAST FAVORITE WEATHER is:
a) Cold, windy weather.
b) Hot weather.
c) Cold, damp weather.
18) Which best describes the illnesses you're susceptible to? PRONE TO
a) Constipation, anxiety, nervousness, and/or insomnia, pain arthritis, mental instability,
bad thoughts.
b) Inflammation, hypertension, hypersensitivity (allergies, rashes, arthritis, etc) and/or
aggression,
c) Congestion, water retention, cystic acne, and/or lethargy, respiratory diseases.
19) Which best describes you? NATURE
a) Impatient and somewhat restless; high energy.
b) Critical, perfectionist, stubborn, and easy to anger.
c) Even-tempered, patient, compassionate, and not particularly high-energy.
20) Which best describes your EMOTIONAL TENDENCY?
a) Fear, worry, anxiety,
b) Anger, jealousy, irritable.
c) Complacent, steady, slow.
21) Which best describes your MENTAL TENDENCY?
a) Questioning, theorizing,.
b) Judging, discriminating.
c) Logical, stable.
22) Which answer best applies to you? RESPONSE TO STRESS
a) Under stress, I am easily excited.
b) Under stress, I can be angry or critical.
c) I’m pretty easygoing; it takes a lot to stress me out.
23) Which answer best applies to you? ATTENTION SPAN
a) I have a short attention span.
b) I am detail-oriented and can focus for long periods of time.
c) I am a “big-picture” person and can focus for long periods of time.
24) Which answer best applies to you? SPENDING
a) I like to shop and often spend too much money.
b) I don’t like to spend money, except on special items.
c) I prefer not to spend at all; I’m good at saving money.
25) Which answer best applies to you? FOCUS
a) I am good at getting things started but not necessarily at finishing them.
b) I am very organized and will see a project through from start to finish.
c) I may need help getting things started, but I am good at getting things accomplished.
26) Which answer best applies to you? FRIENDSHIP
a) I tend to make and change friends often.
b) Most of my friends are work-related and change when I change jobs.
c) My friendships are long-lasting and sincere.
27) Which answer best applies to you? MOODS
a) My moods change quickly.
b) My moods change slowly.
c) My moods are mostly steady.
28) Which answer best applies to you? FORMING OPINION
a) I have lots of ideas and change my mind about things easily.
b) I am stubborn; I make up my mind quickly and don’t change my mind often.
c) I gather lots of facts before forming an opinion.
29) Which answer best applies to you? MEMORY
a) I learn quickly and forget quickly.
b) I have a good general memory.
c) I learn slowly and have a good long-term memory.
30) Which answer best applies to you? TEMPERATURE OF EXTREMITIES
a) My hands and feet tend to be cold.
b) My hands are usually warm and sweaty.
c) My hands are usually cool.
31) Which best describes your skin? SKIN
a) Thin, dry, rough, flaky, cracked; superficial veins easily visible;
b) Warm, moist, oily, soft, moles, freckles, acne.
c) Thick, moist, cold, smooth.
32) Which best describes your COMPLEXION?
a) Darkish, dull
b) Red, ruddy
c) Pale, whitish
33) Which best describes your VOICE?
a) Weak, low, hoarse, whinny, with vibrations.
b) Sharp, high pitched,
c) Pleasant, deep, resonant.
34) Which best describes your SPEECH?
a) Talkative, fast, interrupts.
b) Precise, argumentative, convincing, sharp, laughing.
c) Slow, monotonous, low, harmonious.
35) Which best describes your SEX DRIVE?
a) Frequent desire, low energy.
b) Moderate, dominating, passionate.
c) Cyclical, infrequent, good energy, devoted
Body Parts:
1) Teeth:
a) Crooked, large, protruding, receding gums.
b) Medium size, gums bleed easily, yellowish.
c) Large, white.
2) Eyes:
a) Small, dull, dry, brown, black, unsteady.
b) Sharp, penetrating, red sclera, green, gray.
c) Big, attractive, charming, blue, white sclera.
3) Eyebrows:
a) Thin, dry, firm.
b) Medium.
c) Thick, large, oily, firm, oily.
4) Nose:
a) Thin, small, crooked
b) Medium
c) Thick, large, firm, oily.
5) Lips:
a) Thin, small, dry, unsteady, darkish.
b) Medium, soft, pink.
c) Thick, large, smooth, firm.
6) Shoulders:
a) Thin, small, down sloping.
b) Medium
c) Thick, broad, firm.
7) Chest:
a) Thin, narrow, under developed.
b) Medium
c) Thick, broad, well developed.
8) Arms:
a) Thin, small, bony.
b) Medium
c) Large, thick, long, well developed.
9) Hands:
a) Small, dry, cold, unsteady,
b) Medium, warm, pink, moist.
c) Large, thick, oily, cool, firm.
10) Calves:
a) Small, firm.
b) Loose, soft.
c) Firm, shapely, round.
11) Feet:
a) Small, dry, rough.
b) Medium, soft, pink.
c) Large, thick, solid.
12) Joints:
a) Thin, small, make sound.
b) Medium, soft, loose.
c) Large, thick, well knit.
13) Nails:
a) Small, dry, rough.
b) Medium, pink, soft.
c) Large, thick, smooth, white, hard.
14) Hair:
a) Tends to be dry, coarse, black, kinky, dark brown, curly.
b) Soft, fine, light brown, reddish, or prematurely gray; balding;
c) Abundant, thick, oily, wavy, and medium to dark brown.