Ayurvedic Assessment

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Postal / Zip Code

	Tall or short, thin, underdeveloped physique	Medium height, moderately developed physique	Stout, stocky, big well developed physique
Lifetime
Present

	Light, hard to hold weight	Moderate Weight	Heavy gains weight easily
Lifetime
Present

	Dry, rough or cracked, prominent veins	Moist, pink, freckles	Pale, moist, soft
Lifetime
Present

	Cold	Warm/hot	Cool
Lifetime
Present

	Coarse, dry, prone to split ends	Fine, soft, early grey or balding	Abundant, oily, thick, lustrous
Lifetime
Present

	Small, thin or long	Medium sized, oval	Large, round
Lifetime
Present

	Crooked	Medium sized	Large and even
Lifetime
Present

	Dark, receding	Red, bleed easily	Soft, pink
Lifetime
Present

	Narrower than teeth, long and thin	Same width as teeth, oval shaped front	Wider than teeth, thick, rounded front
Lifetime
Present

	Fine, dry, cold, long fingers	Symmetrical, pink, warm	Large, thick and short fingers
Lifetime
Present

	Thin, rough, fissured, cracked, darkish	Strong, pinkish	Thick, smooth and pale
Lifetime
Present

	Variable or weak, allergies maybe an issue	Strong, can digest almost anything	Medium or slow but steady
Lifetime
Present

	Variable, erratic	Strong	Constant
Lifetime
Present

	Intestinal wind	Acidity or burning	Bloating, heaviness or nausea
Lifetime
Present

	2-4 times per day	4-6 times per day	3-5 times per day
Lifetime
Present

	Dry, hard, difficult or painful, wind, tends towards constipation	Abundant, loose, sometimes yellowish, tends towards diarrhoea	Moderate, solid, sometimes pale in colour or has mucus in the stool
Lifetime
Present

	Little with no smell	Profuse, hot, strong smell	Moderate, neutral smell
Lifetime
Present

	Poor, variable, cold hands and feet	Good, warm hands and feet	Slow but steady, cool hands and feet
Lifetime
Present

	Poor, variable, weak immune system	Medium, prone to infections	Good, consistent, strong immune system
Lifetime
Present

	Low endurance, starts and stops	Moderate level of endurance	Strong, good endurance, can be slow in starting
Lifetime
Present

	Binges, snacks, forgets to eat	Likes regular plentiful meals	Eats constantly, overeats regularly
Lifetime
Present

	Beans, cabbage family	Onions, tomatoes, fried foods	Dairy, salt	None
Lifetime
Present

	Dry, sweet or salty, crispy snack foods	Spicy, salty or hot	Sweet, creamy, cold	None
Lifetime
Present

	Dislikes cold, wind, sensitive to dryness and likes the warmth	Dislikes heat or direct sun, like coolness	Dislikes cold, damp, likes wind and sun	None
Lifetime
Present

	Quick, talkative, inconsistent, erratic	Moderate, argumentative, convincing	Slow, concise, not talkative
Lifetime
Present

	Quick, adaptable, indecisive, impulsive	Factual, penetrating, critical	Slow, steady
Lifetime
Present

	Quick but soon over	Hot, irritated or defensive, grudge	Slow but bothered for a long time
Lifetime
Present

	Anxious, fearful, nervous, worries	Frustrated, irritable, angry, dominating	Calm, attached, greedy, sentimental
Lifetime
Present

	Hysteria, anxiety attacks, depression	Extreme temper, rage, tantrums	Sorrow, unresponsive, depressive, grief
Lifetime
Present

	Relates very easily, can be superficial	Relates well, can be dominating	Relates with difficulty
Lifetime
Present

	Not very important, erratic	Important to know about, purposeful	Important to have or own, practical
Lifetime
Present

	Not very important	Useful to gain control or respect	Very important
Lifetime
Present

	Spends easily	Spends for a purpose	Spends with difficulty
Lifetime
Present

	Has many light touch	Has several close relationships	Has few but very deep
Lifetime
Present

	Tends to have many, erratic	Tends to have a few, marries for a reason	Single life partner, very faithful
Lifetime
Present

	Change frequently, not so important	Determined, very important	Fixed early in life
Lifetime
Present

	Light, tends towards insomnia, restless	Moderate, may wake up but will fall asleep again	Heavy, difficult in waking up in the morning
Lifetime
Present

	Asleep before 10pm	Asleep before 12 midnight	Asleep after 12 midnight
Lifetime
Present

	Feels light and refreshed on waking	Wakes up with difficulty, feels groggy and tired
Lifetime
Present

	26-28 days	28 days	28-30 days	Varies
Lifetime
Present

	2-3 days	3-5 days	4-7 days	Varies
Lifetime
Present

Food and Lifestyle Diary

To get the most out of your consultation it is recommended that you observe your dietary and lifestyle habits over a week or so and bring the information along to your appointment.

Booking and Payment

Your booking is secured once payment has been received, please make payment now.

Payment details:

Joanne Lovell

Account - 14830772

Sort Code - 60-83-71

The personal information you have submitted is treated in the strictest confidence.

Thank you for completing this assessment, it will form the basis of your consultation and help to make the time more efficient.

Cancellation Policy: At least 48 hours’ notice is required should you require to cancel or rearrange an appointment to enable me to rearrange my schedule. It is difficult to slot other clients in at short notice.
If you cancel your consultation with at least 48 hours notice, 100% refund is given, with less notice the full cost is due.

By submitting this form you are agreeing to my Ayurvedic Consultation Terms and Conditions. Please read these carefully.

Jo Lovell - Ayurvedic Assessment

Physical Body

Metabolism

Diet

Psychological/Emotional/Relationships

Sleep

Menstruation