Vakriti, current condition

Vakriti, current condition

Filling out this form will give me information to determine your current condition (vakriti). You must put an answer in every box, even if it is just an approximation, and then click submit, or the form will not go through.

Name *

email address *

1. I have been feeling nervous, fearful, panicky, anxious or frantic. *

yes

no

2. I have twitches, tics, tremors or spasms in my body and I fidget a lot. *

yes

no

3. My skin is dry and easily chapped *

yes

no

4. I have been suffering from dry, hard stools, constipation, gas, or bloating. *

yes

no

5. I feel I am underweight. *

yes

no

6. Lately I have a stronger dislike of the wind and cold than usual. *

yes

no

7.I have a difficult time tolerating loud noise. *

yes

no

8. My sleep has been light, interrupted, restless or disturbed. *

yes

no

9. I feel scattered, spacey and have difficulty concentrating or have poor memory. *

yes

no

10. I have been having loose stools. *

Yes

No

11. I am prone to over-thinking or worrying. *

yes

no

12. I have a red, inflamed or burning rash, acne, cold sores or fever blisters. *

yes

no

13. I have acid reflux, heartburn, acid indigestion or a gastric or peptic ulcer or a tight, burning feeling in my stomach or digestive tract. *

yes

no

14. I feel nauseated or uncomfortable if I miss a meal. *

yes

no

15. My digestive system alternates between constipation and diarrhea. *

yes

no

16. I have been feeling uncomfortably warm or hot. *

yes

no

17. I have been feeling frustrated, irritable or angry. *

yes

no

18. I can be easily judgmental, impatient, critical or intolerant of others. *

yes

no

19. My eyes have been red, bloodshot, inflamed or sensitive to light. *

yes

no

20. I expect perfection of myself or others. *

yes

no

21. I have excess mucous in my body or nasal or lung congestion. *

yes

no

22. I have a thick, white coat on my tongue. *

yes

no

23. My bowel movements are slow, sticky, sluggish, or feel incomplete. *

yes

no

24. I am overweight. *

yes

no

25. It is difficult for me to wake up in the mornings, even if I sleep deeply for 8-10 hours, and I feel lethargic throughout the day. *

yes

no

26. I have been feeling slow, foggy, dull, lethargic or heavy. *

yes

no

27. In the morning I have to cough up a lot of mucous. *

yes

no

28. I have a deep, wet cough that produces a lot of mucous. *

yes

no

29. I feel complacent, stubborn and resistant to any change, or my close friends and family tell me that I am very slow to change or to make a decision. *

yes

no

30. I am prone to excessive emotional eating, especially of sweet, heavy foods. *

yes

no