Dosha Evaluation Learn more If you are a human and are seeing this field, please leave it blank. First name Last name Email Phone Postcode Reason for Consultation Vata rating Pitta Rating Kapha Rating Dosha Evaluation Please tick the boxes below which best describe aspects of your body and lifestyle. We are not looking at how you are now but rather what you have been like most of your life. You may tick more than one box in each row if you fall into more than one category. Part I – Characteristics Which Do Not Change Body frame Thin & unusually tall or very short; poorly developed physique Medium body, moderately developed physiqueLarge body, or short but stout, stocky, well developed physique Bone Structure Light, small bones and/or prominent jointsMedium bone structureHeavy bone structure Fingers & Toes Long tapering fingers and toesFingers and toes medium in lengthFingers and toes short and squarish Build as a child Thin as a childMedium build as a childLarge or chunky as a child Gaining Weight Low, hard to hold. If gains weight around the middle. Prominent veins and bones Moderate, good muscles. If gains weight, deposits fat evenlyHeavy. Tends to gain weight, especially in rear and thighs. Tends towards obesity Complexion Dull, dark complexion (relative to family — tans easily)Fair skin, sun-burns easily, freckles and moles common. Flushed or growingWhite, pale. Tans evenly Body Hair Body hair scanty or overabundant, tends to be dark, coarse and curlyLight body hair, fine textureModerate amount of body hair Forehead Small foreheadMedium forehead with folds and linesLarge forehead Eyes Small, dark, active eyesMedium size, light green, gray, amber or blue eyesLarge, liquid, sometimes blue, often chocolate brown eyes Teeth Crooked, uneven or buck teeth that are sensitive to heat and cold, may have needed bracesEven teeth, of medium sizeLarge, even, gleaming teeth Neck Neck small, unsteadyModerate neckLarge, steady neck Chin Delicate chinModerate chinLarge jaw Hair As a child, hair kinky, curly, tends to dry hair.As a child, hair fine, light. Early gray or bold As a child, hair wavy & thick. Abundant, oily lustrous Part II – Characteristics Which Change Gaining Weight Difficulty gaining weightCan loose or gain weight if puts mind to itGains weight easily, hard time loosing without exercise Skin texture and temperature Thin, dry, rough, cracked. Cold hands and feet. moist to oily, pink or yellowish. Skin warm to touchThick, white, moist but cool and pale. Soft and Smooth. Skin Dry skin (¼" thick - pinch skin on forearm), chaps easily. Prone to corns and callousesOily skin, prone to pimples and rashes (¼" – ½" thick)Thick skin (¾+" thick), well lubricated Lips Thin and small, unsteady. Often suffers cracked, chapped lipsMediun, soft, deep, red lips, tendency toward cold sores, fever blistersFull, firm, moist lips. Hair Dry hair, lusterless, split ends, dark, rough, wiry or kinkyFine, light, oily, blonde, red or early gray hair, early thinning or baldness possibleThick, slightly wavy hair, a little oily, dark, brown, lustrous Climate Dislikes dryness and cold (likes warmth)Prefers cool, well-ventilated places (dislikes heat)Tolerates most climates (dislikes humidity) Tongue Tongue dry with thin, grayish coatingTongue coating yellowish, orange or reddishTongue swollen with thick, curdy white coating Eyes Eyes often dry and scratchy, sclera (whites of eyes) grayish or bluishSclera has reddish or yellow tingeTendency toward eye puffiness Bowel Movement Bowel movement can be irregular, hard, dry or constipatedBowel loose more than twice a day/diarrheaLarge full bowel movement, once a day, mucous, itching When ill If ill: nervous disorders, sharp pain likelyIf ill: fevers, rashes or inflammation likelyIf ill: swelling, fluid retention, mucous, congestion Arousal Sexual interest variable, fantasy life activeHighly sexed, arouses easilySteady sex, slow to arouse Menses Menses irregular, scanty flow, severe painful crampsMay bleed heavily, and long loose stool accompanies periodProne to water weight during menses, slight cramps, if any Diet Either indulges in rich food or on strict dietLoves proteins, caffeines & hot, spicy, & salty foodsLoves sweets, dairy, bread and pastry Gums Receding gumsInflamed, bleeding gumsThick gums Joints Joints painful, unsteady, cracking or stiffJoints hot, swollen, burningJoints loose, aching, watery, swollen Part III – The Mind Memory Concentration is short, short-term memory good, but forgets quicklyGood short & long-term memory, logical, rational thoughtsTakes time to learn things, once learned never forgets Routine Dislikes routineEnjoy planning & organising, especially if self-createdWorks well with routine Making Decisions Difficulty deciding, changes mind easilyRapid decision making, sees things clearlyTakes time making decisions, sticks with it Activities Restless, active, likes movementAggressive, likes competitive activitiesCalm, likes to relax, leisure activities Thought Creative thinkerOrganised thinkerPrefers to follow a plan or idea Organisation Does many projects all at onceConstantly organising, likes to proceed in orderly fashionResists change, new projects; likes simplicity Friendships Knows a lot of people, few close friendsVery selective, but creates warm friendships/makes enemies easilyLoyal with many friends Spending Spends impulsively, money is to be usedPlans spending, money is for achieving purposeSpends reluctantly, likes to save Part IV – The Emotions Common Experiences Experiences fearExperiences hateExperiences apathy Behaviour Practices secretivenessCan be vindictiveCan be uncaring Destructiveness Can be self-destructiveCan be destructiveFeels victimised Reaction AnxiousIrritableAttached Tactics SneakyManipulativeGreedy Mood NervousAngryDesirous Outlook DynamicPerceptiveHarmonious Approach CommunicativeCaringDevoted Skills FlexibleTolerantPatient Expression Feelings and emotions change easilyAggressive about opinions and feelings, gives opinions even if they are not asked forAvoids giving opinions in difficult situations Dreams Dreams about flying, restless, nightmaresDreams in color, fast, passion, conflictsRomantic, short dreams, often involve water Vata Pitta Kapha
