Shadanga
QUESTIONNAIRE FOR PRAKRUTI ANALYSIS
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Name
 *
  Ph/WA  
 *
  Email:  
 *
  Date:  
 *
MM
/
DD
/
YYYY
  1. BUILT   
 *
Required
  2. NAILS   
 *
Required
  3. HAIR  
 *
Required
  4. SKIN TEXTURE  
 *
Required
  5. NOSE  
 *
Required
  6. EYES   
 *
Required
  7. VOICE  
 *
Required
  8. THIRS  
 *
Required
  9. APPETITE  
 *
Required
  10. BOWEL  
 *
Required
  11. TOLERANCE TO CLIMATE  
 *
Required
12. BEHAVIOR
*
Required
13. PHYSICAL ACTIVITIES
*
Required
14. SLEEP
*
Required
15. MEMORY
*
Required
16. DREAMS
*
Required
17. THOUGHTS
*
Required
18. RESPONSE TO PROBLEMS
*
Required
19. ATTITUDE
*
Required
20. TEMPER
*
21. WEIGHT CHANGE
*
Required
22. SKIN TYPE
*
Required
23. HAIR COLOR
*
Required
24. TEETH
*
Required
25. EYE COLOR
*
Required
26. LIPS
*
Required
27. LIP COLOR
*
Required
28. CHIN
*
Required
29. CHEEKS
*
Required
30. NECK
*
Required
31. CHEST
*
Required
32. BELLY
*
Required
33. HIPS
*
Required
34. JOINTS
*
Required
35. TASTE PREFERENCE
*
Required
36. DIGESTION
*
Required
37. INDIGESTION
*
Required
38. SPEECH
*
Required
39. FINANCIAL
*
Required
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