DOSHA QUIZ

Aloha!

Please fill out the questionnaire below either by printing and marking the form, or marking your results on a separate piece of paper. Bring your results with you to your first Ayurvedic Yoga Massage so that your massage therapist can adjust your treatment accordingly.

DOSHA QUIZ

Name: _________________________________________________ Date: _______________________

This mind-body questionnaire gathers information about your basic nature – the way you were as a child or the basic patterns that have been true most of your life. If you developed an illness in childhood or as an adult, think of how things were for you before that illness.

Instructions: PLEASE READ CAREFULLY!

Rank each characteristic with either 5, 3, or 1. For each row, use each number one time (each row should add up to 9).

5 = Most accurately represents me 3 = Secondarily represents me 1 = Rarely represents me

EXAMPLE

3

VATA

5

PITTA

1

KAPHA

CHARACTERISTICS

VATA

PITTA

KAPHA

FRAME

I am thin, lanky and slender with prominent joints and thin muscles.

I have a medium, symmetrical build with good muscle development.

I have a large, round or stocky build. My frame is broad, stout or thick.

WEIGHT

LOW; I may forget to eat or have a tendency to lose weight.

MODERATE; it is easy for me to gain or lose weight if I put my mind to it.
HEAVY; I gain weight easily and have difficulty losing it.

EYES

My eyes are small and active.
I have a penetrating gaze.
I have large pleasant eyes.

COMPLEXION

My skin is dry, rough or thin.

My skin is warm, reddish in color and prone to irritation.

My skin is thick, moist and smooth.

HAIR

My hair is dry, brittle or frizzy.

My hair is fine with a tendency towards early thinning or graying.

I have abundant, thick and oily hair.

JOINTS

My joints are thin and prominent and have a ten- dency to crack.
My joints are loose and flexible.
My joints are large, well knit and padded.

SLEEP PATTERN

I am a light sleeper with a tendency to awaken easily.

I am a moderately sound sleeper, usually needing less than eight hours to feel rested.

My sleep is deep and long. I tend to awaken slowly in the morning.

BODY TEMPERATURE

My hands and feet are usually cold and I prefer warm environments.

I am usually warm, regardless of the season, and prefer cooler environments.

I am adaptable to most temperatures but do not like cold, wet days.

TEMPERAMENT

I am lively and enthusiastic by nature.
I like to change.

I am purposeful and intense. I like to convince.

I am easy going and accepting. I like to support.

UNDER STRESS …

I become anxious and/or worried.

I become irritable and/or aggressive.

I become withdrawn and/or reclusive.

TOTAL

____ VATA TOTAL

_____ PITTA TOTAL

_____ KAPHATOTAL

Note: Each row should add up to 9. VATA TOTAL, PITTA TOTAL, and KAPHA TOTAL should add up to 90.

DOSHA BALANCING TIPS

VATA

When Vata is out of balance, too much air has accumulated in mind, body, and environment. The result is a sense of un-groundedness. The best way to balance excess Vata is to bring more Earth and stability into the physiology.

Think relaxing.

PITTA

When Pitta is out of balance, too much fire has accumulated in mind, body, and environment. The result is a sense of internal and external combustion. The best way to balance excess Pitta is to bring more space and coolness into the physiology.

Think soothing.

KAPHA

When Kapha is out of balance, too much Earth has accumulated in mind, body, and environment. The result is
a sense of sluggishness, congestion, and dullness. The best way to balance excess Kapha is to bring more movement and circulation into the physiology.

Think invigoration.