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Assessment Tool

Reason for visit

Let's know your reason for coming in today


Medical History

Please indicate if you have/had any of these conditions


Family medical history

Please indicate if either of your biological parents has/had any of these conditions


Daily diet


Habits

Please be as honest as possible


Painful or Distressed Areas

Indicate painful or distressed areas below (Please check all relevant boxes)


Pregnancy & Gynecology (if applicable)


Ama Test

For each statement below, select a rating from 1 to 10 where 1 means "Not at all" and 10 means "Very much so".


Mental Prakriti

Please answer every question without overthinking it. These questions focus on your general state of mind, so choose the answer that is closest to how you feel most often in your waking life


Prakriti Test

Answer these questions to reflect how you have ALWAYS been, especially when healthy – NOT how you are right now. Don't overthink it. You might not find an option that is EXACTLY like you are, so just choose the one that seems closest. Please choose only one answer per question.


Vikriti Test

Please read the questions carefully and complete every question on this form, including your name and email address below. You might consider asking someone you trust / who is close to you to help you with some of these observations.

Answer these questions to reflect how you are NOW, today (not "in general", but during the last week up to today only). Some questions may not have an answer that describes you exactly, just choose the answer that is closest. Don't overthink it.


Agni Test (Digestive Fire)

Please choose the answer that is closest to how you have been feeling in the last few days. There might not be an answer that describes you to the letter, don't overthink it, just choose the closest option. It is essential that you be completely honest in this form (even if some of the questions feel a bit uncomfortable) as it is a very important test. Your answers are completely confidential, as is all your other information. It is tempting to answer as one would LIKE to be, or as we see ourselves on good days, but being totally honest with yourself in this test will form the basis of your treatment.


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The DoSha Way

Dosha Balance provides five comprehensive assessments to evaluate different aspects of a client’s Ayurvedic profile.

  • Prakriti
  • Vikriti
  • Mental Prakriti
  • Ama
  • Agni
  • Client Management
  • Personalized Recommendations