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Confidential Intake

Vanyasiri Ayurveda

To provide you with the most authentic and personalized healing journey, please share the details of your constitution and current state of health.

1

Personal Identification

Gender:
2

Anthropometric Data

Body Frame Breadth:
Body Frame Length:
3

Physical Constitution (Prakriti)

Skin Profile

Appearance:
Nature:
Predominant Color:

Hair Profile

Nature:
Color:
Prone to:

Nails

Color:
Nature:

Teeth

Color:
Shape:
Size:

Lips & Palate

Color:
Tendency:
4

Digestive & Metabolic Health (Agni)

Primary Taste Preference:
Food/Beverage Temperature:
Appetite Frequency:
Appetite Amount:
Overall Digestive Capacity:

Bowel Habits

Frequency:
Tendency:
Consistency:
5

Lifestyle & Mental Health (Manasika)

Sleep Profile

Amount:
Quality:

Cognition & Memory

Memorizing Speed:
Forgetfulness:
Body Temperature:
Perspiration:
Body Odor:
Speaking Speed:
Speaking Amount:
Work Quality:
6

Immunity & Seasonal Patterns

Physical Power:
Mental Power:
Resistance to Illness:
Healing Power:

Seasonal Sensitivity

Increased problems in season:
7

Present & Past Health History

Medical Records

Have reports, prescriptions or scans? After you send your profile, simply attach them (PDF, JPG or PNG) in the same WhatsApp chat — they reach the practitioner directly.

Sent over end-to-end encrypted WhatsApp.
Your health data is strictly confidential.