Healing Fern Ayurveda Questionnaire
For the Ayurvedic profile questions on the next few pages: Select the phrase that best describes your qualities for each of the categories. The questionnaire is compartmentalized into 5 categories - Mental, Behavioral, Emotional, Physical, and Fitness. This will help us dive deeper into understanding your Ayurvedic Dosha(s). Thank you for trusting me with your Ayurvedic journey!
Directions:
Please be very honest with yourself. Choose the best option in each section that suits you most (not the option that you "want" or think you "should be"). You can only pick one option per question. It helps to think of your qualities that have been prominent within the past 6 years, at least. All of your information is confidential. Feel free to reach out to me with any questions by emailing info@healingfern.com or text 678-575-0531. Once you submit your questionnaire, I will analyze and reach back out via email/text within 24-48hrs to go over your results. We can discuss next steps from there depending on what type of guidance you're looking for (self-care suggestions, meditation, pranayama (breath work), movement and yoga routines, food recommendations, aromatherapy and/or therapeutic art making).
Additional Notes:
For some people one dosha is very clear and dominant, while others are a combination of two or all three. Taking this quiz is a place to simply begin and inquire within through a compassionate lens. For example, if your grand total of all categories shows strong Vata dominance with Pitta secondary, but your Behavioral Profile is overwhelmingly Kapha, that would be an area of your life worth looking into and meditating on. This quiz is inspired by my 300hr training with Indra Yoga Instituteš¤
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number. I will only text you with updates on your Ayurvedic Questionnaire, or for any follow up consultations as needed. No spam or promotional texts.
Format: (000) 000-0000.
Mental Profile
Mental Activity
Quick mind, restless
Calm, steady, stable
Sharp intellect, aggressive
Memory
Short-term best
Long-term best
Good general memory
Thoughts
Constantly changing
Steady, stable, fixed
Fairly steady
Concentration
Short-term focus best
Good ability for long-term focus
Better than average mental concentration
Ability to learn
Quick grasp of learning
Slow to learn new things
Medium to moderate grasp
Dreams
Fearful, flying, running, jumping
Include water, clouds, relationships, romance
Angry, fiery, violent, adventurous
Sleep
Interrupted, light
Sound, heavy, long
Sound, medium
Speech
Fast, sometimes missing words
Slow, clear, sweet
Fast, sharp, clear-cut
Voice
High pitched
Low pitched
Medium pitched
Behavioral Profile
Eating Speed
Quick
Slow
Medium
Hunger Level
Irregular
Can easily miss meals
Sharp, needs food when hungry
Food and Drink
Prefers warm
Prefers dry and warm
Prefers cold
Weather Preference
Aversion to cold
Aversion to damp, cool
Aversion to heat
Friendships
Tends toward short-term friendships, makes friends quickly
Tends to form long-lasting friendships
Tends to be a loner, friends related to occupation
Achieving goals
Easily distracted
Slow and steady
Focused and driven
Reaction to stress
Excites quickly
Slow to get excited
Medium
Works best
While supervised
In groups
Alone
Emotional
Moods
Change quickly
Steady, unchanging
Change slowly
Reacts to Stress with...
Fear
Indifference
Anger
Relations with Partner/Spouse
Clingy
Secure
Jealous
Expresses affection
With words
With touch
With gifts
More Sensitive to...
Own feelings
Others' feelings
Not sensitive
When Feeling Hurt
Cries
Withdraws
Argues
Emotional Trauma Causes...
Anxiety
Depression
Denial
Confidence Level
Timid
Inner confidence
Outwardly self-confident
Physical
Amount of Hair
Average
Thick
Thin
Hair Type
Dry
Oily
Normal
Natural Hair Color
Light brown, blonde
Dark brown, black
Red, auburn
Skin
Dry, rough, or both
Oily, moist, cool
Soft, normal to oily
Skin Temperature
Cold hands/feet
Cool
Warm
Complexion
Darker
Pale-white
Pink-red
Eyes
Small
Large
Medium
Size of Teeth
Very large or very small
Medium-large
Small-medium
Weight
Thin, hard to gain
Heavy, gains easily
Medium
Elimination
Dry, hard, thin, easily constipated
Heavy, slow, thick, regular every day
Many during the day, soft to normal
Veins and Tendons
Very prominent
Well covered, not prominent
Fairly prominent
Fitness
Exercise Tolerance
Low
High
Medium
Endurance
Fair
Excellent
Good
Strength
Fair
Excellent
Better than average
Speed
Very good
Not so fast
Good
Competition
Doesn't like competitive pressure
Deals easily with competitive pressure
Driven competitor
Walking Speed
Fast
Slow and steady
Average
Muscle Tone
Lean, low body fat
Brawny/bulky, with higher fat percentage
Medium, with good definition
Runs Like a ..
Deer
Bear
Tiger
Body Size
Small frame, lean, or long
Large frame
Medium frame
Reaction Time
Quick
Slow
Average
Please let me know if you have any questions, concerns, or would like to give me any other information in the space below. I'm looking forward to going over this with you soon!
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