Welcome to Soothing Essentials Intake Form

This intake form is to give a general idea of your body type! What this intake form will do for you. After filling out and submitting the form. A link will be sent to you with a list of foods to avoid in order to help balance your body. This intake is for general information only! This is a free service provided by Soothing Essentials.
On each line check the box which best describes you. Occasionally, more than one statement will best describe you or none at all.

Ayurveda
No Change In Body types
The choices that you make here reveal your original metabolic type. Life style, diet, climate, etc. can and will change this.

Body Type Vata
  1. Thin and unusally tall or short.
  2. Light, small bones and /or prominent joints
  3. Long tapering fingers and toes
  4. Thin as a child
  5. If gains weight, around middle.
  6. Dark complexion ( relative to family- tans easily)
  7. Body hair scanty or overabundant, tends to be dark, coarse and curly
  8. Small forehead.
  9. Small dark active eyes
  10. Crooked, uneven or buck teeth that are sensitive to heat and cold, may have needed braces.
  11. Neck small unsteady
  12. Delicate chin
  13. As a child hair kinky, curly
  • Total
    		•
    Body Type Pitta
    1. Medium body
    2. Medium bone structure.
    3. Fingers and toes medium in length
    4. Medium build as a child
    5. If gains weight, deposits fat evenly.
    6. Fair skin, sunburns easily, freckles and moles common
    7. Light body hair fine texture

    8. Medium forhead with folds and lines

    9. Medium size, light green, gray , amber or blue eyes
    10. Even teeth, of medium size
    11. Moderate neck
    12. Moderate chin
    13. As a child, hair fine, light.
  • Total
    		•
    Body Type Kapha
    1. Large body
    2. Heavy bone structure.
    3. Fingers and toes short and squarish
    4. Tends to gain weight, especially in rear and thighs.
    5. Tans evenly
    6. Moderate amount of body hair
    7. Large, liquid, sometimes blue, often chocolate brown eyes
    8. Large, even, gleaming teeth.
    9. Large , steady neck.
    10. Large jaw
    11. As a child hair wavy and thick
  • Total

    • Ayurveda
    Changing body type
    This Shows where Your body Balance is Now.

    Body Type Vata
    1. Difficulty gaining weight.
    2. Cold hands and feet.
    3. Dry skin (1/4" thick- pinch skin on forearm), chaps easily. Prone to corns and callouses.
    4. Often suffers cracked , chapped lips
    5. Dry hair, lusterless, split ends, dark , rough , wiry or kinky. Dislikes dryness and cold( likes warmth).
    6. Tongue dry with thin, grayish coating.
    7. Eyes often dry and scratchy, sclera (whites of the eye) grayish or blueish
    8. Bowel movement can be irregular, hard, dry or constipated
    9. If ill: nervous disorders, sharp pain likely.
    10. Sexual interest variable, fantasy life active.
    11. Menses irregular, scanty flow, severe painful cramps
    12. Either indulges in rich food or on strict diet.
    13. Receding gums.
    14. Joints-painful, unsteady, cracking or stiff.
  • Total
    		•
    Body Type Pitta
    1. Can gain or lose weight if puts mind to it
    2. Skin warm to touch
    3. Oily skin, prone to pimples and rashes (1/4"-1/2' thick)
    4. Deep, red lips, tendency toward cold sores, fever blisters.
    5. Fine , light, oily, blonde, red or early gray hair, early thinning or bald-ness possible
    6. Perfers cool, well ventilated places
    7. Tongue coating yellows, orange or reddish
    8. Sclera has reddish or yellow tinge.
    9. Bowels loose more than twice a day/diarrhea
    10. If ill: fevers, rashes or inflamaton likely.
    11. Highly sexed, arouses easily
    12. May bleed heavily, and long loose stool accompanies period
    13. Loves proteins, caffeines & hot , spicy, & salty foods.
    14. Inflamed, bleeding gums
    15. Joints hot, swollen, burning
  • Total
    		•
    Body Type Kapha
    1. Gains weight easily, hard time losing without exercise.
    2. Skin cool but not cold.
      Thick skin ( 3/4" thick), well lubricated.
    3. Full moist lips.
    4. Thick, slightly wavy hair, a little oily, dark, brown, lustrous.
    5. Tolerates most climates ( dislikes humidity )
    6. Tongue, swollen with thick, curdy white coating.
    7. Tendency toward eye puffiness.
    8. Large full bowel movement, once a day/mucous, itching.
    9. If ill: swelling, fluid retention, mucous,congestion
    10. Steady sex, slow to arouse.
    11. Prone to water weight during menses, slight cramps if any.
    12. Loves sweets, dairy, bread and pastry.
    13. Thick gums.
    14. Joints loose, aching, watery, swollen.
  • Total

    • Ayurveda
    Mind
    The mind of each metabolic type demonstrates favorable and unfavorable characteristics.

    Body Type Vata
    1. Concentration is short, short-term memory good but forgets quickly.
    2. Dislikes routine.
    3. Difficulty deciding , changes mind easily.
    4. Restless, active, likes movement.
    5. Creative thinker.
    6. Does many projects all at once.
      7. Knows a lot of people, few close friends.
    7. Spends impulsively, money is to be used.
  • Total
    		•
    Body Type Pitta
    1. Good short-and long term memory, logical, rational thoughts.
    2. Enjoy planning & organizing, especially if self created.
    3. Rapid decision making, see things clearly.
    4. Aggressive, likes competive activities
    5. Organized thinker.
    6. Constantly organizing , likes to proceed in orderly fashion.
    7. Very selective, but creates warm friendships/makes enemies easily
    8. Plans spending, money is for achieving purpose.
  • Total
    • Body Type Kapha
    1. Takes time to learn things, once learned, never forgets.
    2. Works well with routine
    3. Takes time making decisions, sticks with it.
    4. Calm, likes to relax, leisure activities
    5. Prefers to follow a plan or idea.
    6. Resists change, new projects;likes simplicity.
    7. Loyal , with many friends
    8. Spends reluctantly, likes to save.
  • Total

    • Ayurveda
    Emotions
    The emotions as well as the mind will show favorable and unfavorable characteristics

    Body Type Vata
    1. Experiences fear.
    2. Practices secretiveness.
    3. Can be self destructive
    4. Anxious
    5. Sneaky
    6. Nervous
    7. Dynamic
    8. Communicative
    9. Flexible
    10. Feelings and emotions change easily
  • Total
    • Body Type Pitta
    1. Experiences hate
    2. Can be vindictive
    3. Can be destructive
    4. Irritable
    5. Manipulative
    6. Angry
    7. Perceptive
    8. Caring
    9. Tolerant
    10. Aggressive about opinions and feeling, gives opinions even if they are not asked for.
    11. Dreams in color, fast, passion, conflicts.
  • Total
    • Body Type Kapha
    1. Experiences apathy
    2. Can be uncaring
    3. Feels victimized
    4. Attached
    5. Greedy
    6. Desirous
    7. Harmonious
    8. Devoted
    9. Patient
    10. Avoids giving opinions in difficult situations.
    11. Romantic, short dreams, often involve water.
  • Total

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