A practice of Integrative and Holistic Medicine
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Dr. Peeyush Bhargava is now a Diplomat of the American Board of Integrative Holistic Medicine

Dosha Analysis Questionnaire

Select one answer for each row: the option which you have observed to be the most consistent over a long period of time or growing up. Input from a parent or spouse can be very helpful in accurate analysis. Add the number of answers in each column

Name Date
Email


  Vata - AIR Pitta - FIRE Kapha - EARTH
Body Frame
Body Weight  Low  Medium  Overweight
 
Eyes  Small, active  Sharp, sensitive  Large, beautiful
Nose  Crooked, sharp  Long, pointed  Short, round
Lips  Dry, cracked  Red, inflamed  Smooth, oily
Cheeks  Wrinkled, sunken  Smooth, flat  Plump, rounded
Teeth  Large, thin gums  Tender gums  White, strong gums
 
Skin  Dry, cold, rough  Warm, rosy, oily  Cool, oily, thick
Hair  Dry, brittle, scarce  Straight, oily, bald  Thick, curly, oily
Nails  Rough, dry, brittle  Sharp, flexible,pink  Thick, oily, smooth
 
Neck  Long, thin  Medium  Large, folded
Chest  Flat, sunken  Medium  Expanded
Belly  Flat, sunken  Medium  Pot belly
Hips  Slender  Medium  Heavy
Joints  Cold, cracking  Medium  Large, lubricated
 
Appetite  Irregular, scant  Strong, unbearable  Slow, steady
Thirst  Irregular  Surplus  Little
Digestion  Irregular, bloating  Quick, burning  Prolonged
Bowel Habits  Constipation  Loose stools  Thick stools,sluggish
 
Physical Activity  Hyperactive  Moderate  Slow
Mental Activity  Hyperactive  Moderate  Slow
 
Emotions  Anxiety, fear  Anger, jealousy  Calm, possessive
Faith  Variable  Extremist  Consistent
Intellect  Quick, incorrect  Accurate, sharp  Slow and steady
Memory  Poor remote  Distinct  Slow and sustained]
 
Disease  Pain, Autoimmune, Arthritis, Palpitations  Fever,Inflammation,Migraine, High BP  Overweight,Diabetes, Congestion
Dreams  Fearful  Violent  Romantic
Sleep  Scanty, broken  Little, sound  Prolonged, deep
Speech  Rapid, unclear  Sharp, penetrating  Slow, monotonous
Finances  Spends on trifles  Spends on luxuries  Saves money