Contact Information
Name *
Name
Phone *
Phone
Basic Information
Body Type *
Weight *
Constitutional Analysis
Your skin is dry cracked, flaky or coarse. *
Your skin is dry cracked, flaky or coarse.
Choose the answer that describes you most closely.
My hair tends to be dry. *
My hair tends to be dry.
My stamina and endurance tend to be low or unpredictable. *
My stamina and endurance tend to be low or unpredictable.
My eyes tend to be dry. *
My eyes tend to be dry.
My nails are rough, coarse, and tend to crack easily. *
My nails are rough, coarse, and tend to crack easily.
My urine tends to be scanty / I don't pee very much when I use the restroom. *
My urine tends to be scanty / I don't pee very much when I use the restroom.
My appetite is irregular and highly variable. *
My appetite is irregular and highly variable.
I experience constipation regularly. *
I experience constipation regularly.
I experience diarrhea regularly. *
I experience diarrhea regularly.
My menstrual flow is irregular or scarce.
My menstrual flow is irregular or scarce.
I don't sweat easily, and if I do it's in small amounts. *
I don't sweat easily, and if I do it's in small amounts.
I become aroused easily and unaroused easily. *
I become aroused easily and unaroused easily.
My sex drive is variable. *
My sex drive is variable.
I am often restless and very active in my physical activity. *
I am often restless and very active in my physical activity.
My pulse is shallow and fast. *
My pulse is shallow and fast.
Check your radial pulse by placing two fingers on the inside of your wrist or just under the jaw.
I am a light sleeper.
I am a light sleeper.
I experience insomnia often.
I experience insomnia often.
My dreams contain motifs of flying or moving. *
My dreams contain motifs of flying or moving.
I have nightmares often. *
I have nightmares often.
My memory is poor. *
My memory is poor.
I forget and remember things easily. *
I forget and remember things easily.
I like to be theoretical, I am curious and inquisitive. *
I like to be theoretical, I am curious and inquisitive.
I tend to be indecisive. *
I tend to be indecisive.
I live with a lot of fear and anxiety. *
I live with a lot of fear and anxiety.
I can be very unpredictable. *
I can be very unpredictable.
I make friends easily but friendships tend to be short-lived. *
I make friends easily but friendships tend to be short-lived.
I like traveling often, and impulsively. *
I like traveling often, and impulsively.
I like to be constantly stimulated. *
I like to be constantly stimulated.
I express myself best with sounds and words. *
I express myself best with sounds and words.
I tend to speak very quickly and am talkative. *
I tend to speak very quickly and am talkative.
I crave things that are sweet, sour, salty, oily or hot. *
I crave things that are sweet, sour, salty, oily or hot.