Dosha Balance
© Ingrid Naiman 2007

Legal Statement:

The answers submitted to the questions that follow will be used to determine the relative strength of the vata, pitta, and kapha doshas of the person responding to the questions. The questions and the value of the answers to the questions are based on Ayurveda, the traditional system of medicine of India. The findings help to determine your constitutional type and are not to be used to diagnose any condition.

Confidentiality:

The answers are used solely for the purpose of determining constitutional type. No information will be provided to anyone other than the web owner(s). Your privacy is guaranteed and the connection used to answer the questions is secure.

Please answer the questions as best you can. If you feel that one answer if more correct than the others, choose it. If none of the choices is applicable to you, skip the question. It is important to keep in mind that the more carefully you respond to the questions, the better the script can score your constitutional type. There are no right or wrong answers, only ones that apply to you. Take your time. When you are uncertain, it is better to leave the space blank than to answer since the total is based on percentages of the doshas, not number of questions answered.

Please provide your e-mail address in the space below:
Note: this is the only required field on the questionnaire.

E-mail:
Please supply as much information about yourself as you wish.
Name
Street/P.O. Box
City
State/Province
Zip or Postal Code
Country
Telephone
If you wish to supply your birth data, please do so in the space below:
Day
Month
Year
Place
Time


Source of birth data:
Birth certificate
Baby book
Mother's memory
Family story
Rectification
Other
Was your birth:
Natural
Induced labor
Forceps delivery
Caesarian section
Were you adopted?
Yes
No

1. Gender
Female
Male
2. Height
Please indicate your height (relative to your ethnic heritage):
Very short
Short
Below average in height
Average
Above average in height
Tall
Very tall
3. Bone structure
Light
Medium
Heavy
4. Weight
I have trouble losing weight
My weight is normal
I have trouble gaining weight
My weight fluctuates
5. Original Hair Color
Select as many as apply to you (but no more than one in each section)
Color
Blonde
Red (or reddish)
Brunette
Black
Texture
Thin
Thick (Full)
Dry
Oily
Brittle (split ends)
Soft (pliant)
Stiff
Waviness
Straight
Naturally wavy
Permanent wave
Curly
Kinky
Hair Loss
Falls out easily (especially after washing or brushing)
Receding hairline
Bald
Hair Condition
Dandruff
Prematurely gray/white
Dyed
6. Skin
Select as many as as true for you
Texture
Dry
Cracked
Oily
Smooth
Clammy
Complexion
Pale
Sallow
Rosy
Ruddy
Tan easily
Freckled
Blotchy skin
Blemishes and Infections
Blackheads
Pimples
Acne
Eczema
Psoriasis
Fungal conditions
Itchiness
Rashes
Boils
Moles
"Liver" spots
Keratoses
Vitiligo
History of Malignancies
Basal cell carcinoma(s)
Squamous cell carcinoma(s)
Melanoma(s)
7. Fingernails
Smooth
Brittle (break easily)
Strong
Corrugated (ridges)
Pitted
White spots (sometimes called "moons")
8. Have you lost any of your senses
Answer yes even if the loss was temporary

Smell
Taste
Sight
Hearing
Touch
No sense loss
9. Describe your vision
Select as many as are true
Nearsighted
Farsighted
Astigmatic
Blurry
See floaters
Light sensitive
Have glaucoma or cataracts
10. Describe what you most like to talk about:
Do not select more than three responses
Books
Finances
Ideas
My beliefs
My family
My friends
My past
My goals
My worries
News
Sports
TV and films
Other, please specify:
11. My favorite leisure time activities are:
Do not select more than three responses

Board games (including cards)
Crafts (includes sewing and knitting)
Dining and parties
Gambling
Gardening
Hiking
Listening to music
Movies and television
Reading
Sports
Surfing the Internet
Walking the dog(s)
Yoga
Other, please specify:

12. When you take a vacation, you prefer to
Explore a place you have never been before
Go to a place where there are lots of activities
Return to a place you know where you have memories
Visit a place of exquisite natural beauty
13. Which of the following are true about your digestion?
My appetite is often ravenous
After eating, I often feel bloated
I sometimes have abdominal rumbling
I sometimes suffer from acid reflux
I often have intestinal gas
None of the above
14. Do you crave any of the following foods?
Dairy products (yogurt, cheese, milk, etc.)
Salty foods (chips, nuts, popcorn, etc.)
Sour foods (pickles, lemons, fermented foods, etc.)
Spicy foods (Cajun nuts, chili, etc.)
Sweet foods (candy, desserts. dried fruit, etc.)
None of the above
15. Cholesterol
If you know your cholesterol level, please indicate it
Low
Normal
High
Do not know
16. Blood sugar
If you know your blood sugar level, please indicate it
Low (hypoglycemic)
Normal
High (diabetic)
Fluctuating
Do not know
17. Pulse
If you know your pulse rate, please indicate it
Slow
Normal
Fast
Do not know
18. Describe your memory
All comes back when an association is triggered
I am very analytical and can figure things out when I have to
I have a photographic memory
I learn quickly, but my brain is like a sieve and I'm easily distracted
My memory is good for events that occurred in the past
When I study carefully, I recall details for a long time
My memory is not as good as it used to be
I worry about memory loss and Alzheimer's Disease
19. I am:

An Idealist
A Materialist
A Pragmatist
A Realist
A Romantic
None of the above

20. I would describe myself as:
Choose as many as are appropriate
Adventurous
Anxious
Cautious
Competitive
Daring
Decisive
Enterprising
None of the above

21. I would describe myself as:
Choose as many as are appropriate

Analytical
Curious
Dreamy
Imaginative
Intuitive
Perceptive
Practical
Skeptical
22. I would describe myself as:
Choose as many as are appropriate
Agile
Alert
Athletic
Flexible
Languid
Lumbering
23. Which of the following is true for you
I often feel tired
I am sometimes bored
I feel lethargic
I have lots of stamina
My mind races ahead of my body
24. I am able to set goals and persevere
True
False
Not sure
25. I tend to make a lot of plans for the future
True
False
Not sure
26. I have a good sense of direction
True
False
Not sure
27. Please indicate which of the following bother you
Select as many as necessary
Cold
Draughts (including fans and air conditioning)
Heat
Loud noises
Odors (such as cigarette smoke or strong perfumes)
28. Do you have a history of any of the following
Select as many as necessary
Allergies
Anemia
Anorexia
Anxiety
Asthma
Bipolar Disorder
Broken Bones
Bulimia
Cancer
Chronic Fatigue Syndrome
Cold Hands and/or Feet
Constipation
Creaky Joints
Depression
Diabetes
Diarrhea
Dizziness
Dyslexia
Epilepsy
Extreme Thirst
Fevers
Gallstones
Halitosis (bad breath)
Heart Arrhythmia
Heart Disease
Heartburn (gastric distress)
High Blood Pressure
Hot Flashes
Incontinence
Infections
Infertility
Insomnia
Learning Disorder
Low Blood Sugar (hypoglycemia)
Migraines
Miscarriage (women only — men please don't answer)
Nausea
Nightmares
Osteoporosis
Painful Joints
Panic Attacks
PMS
Pneumonia
Scoliosis
Sinus Problems
Spasms (anywhere in the body)
Stuttering
Substance Abuse
29. Have you had any of the following operations
Select those that are true
Appendectomy
Gallbladder removal
Hysterectomy
Tonsillectomy
Tubal Ligation
Vasectomy
30. I tend to be resistant to change.
True
False
31. I can sometimes be hot tempered.
True
False
32. I spend money nearly as fast as I earn it.
True
False
33. Would you consider yourself:
Select as many as are appropriate
Biased
Curious
Fair-minded
Judgmental
Liberal
Narrow-minded
Open-minded
Tolerant
34. I sometimes experience the following:
Select as many as are appropriate
Anger
Apathy
Depression
Discouragement
Irritability
Nervousness
Panic
Sadness
35. The traits I like most about myself are:
Click as many as are appropriate
Companionable
Compassionate
Dependable
Diplomatic
Encouraging
Friendly
Generous
Loyal
Nurturing
Practical
Sincere
Sociable
Supportive
Sympathetic
Wise
36. I tend to be sensitive about the following:
Select as many as are true about yourself
Appreciation
Being heard in conversations
Fairness
Having my competence acknowledged
Loyalty
My freedom
My space
One on one time together
Recognition
Teamwork
37. When stressed, I tend to become:
Click as many as are true
Aloof
Angry
Careless
Cautious
Cold
Confrontational
Fearful
Impatient
Irritable
More methodical
Nervous
Non-communicative
Panicky
Rigid
Self-indulgent
Upset
Withdrawn
38. I cope with stress by
Select as many as are appropriate
By drinking more
By going into denial
By making more effort
By seeking advice of friends and/or professionals
By seeking intelligent solutions for my problems
By sleeping more
By taking better care of myself
By waiting for the challenges to pass
By withdrawing from the world
39. Which of the following describes your social and political views
You may select one in each group
Views
Conservative
Liberal
Fiscal Conservative - Social Liberal
Progressive
Focus
More interested in human rights
More interested in local issues
More interested in national issues
More interested in global issues
40. Which of the following is most true about you
I am ethical and hard working
I am an idealist and thrive on projects
I am a humanitarian and adamant about equal opportunity
I am protective of myself and family
41. Would you say you are any of the following?
Select as many as are appropriate

Adaptable
Bold
Charming
Competitive
Cynical
Fatalistic
Fun-loving
Gullible
Happy
Hesitant
Hospitable
Impulsive
Intense
Jaded
Naive
Optimistic
Passive
Pessimistic
Sentimental
Serious
Spontaneous

42. What best describes your attitude towards new ideas?
I am curious and want to learn
I am open-minded but wait to draw conclusions
I am slow to accept but willing to examine the facts
I am very resistant to anything that would cause me to change
43. In terms of relationship, would you consider yourself any of the following?
Select as many as are appropriate
Controlling
Demanding
Faithful
Jealous
Possessive
Romantic
Seductive
Sensual
Sentimental
44. Would you consider yourself to have:
A good sense of humor
A sense of fair play
45. Would others describe you as:
Select as many as are appropriate

Ambitious
Bossy
Conventional
Creative
Domineering
Eccentric
Envious
Formal
Gossipy
High spirited
Manipulative
Noble
Patient
Possessive
Sensitive
Do not know

46. What best describes you sexually:
Heterosexual
Homosexual
Bisexual
Celibate
Monogamous
Promiscuous
Sensual
Abstemious
Perverted
Conventional
Experimental
Shy
Curious
Disinterested
Too wounded to know
47. What I enjoy most in friends is
People who are fun to be with
People who are good conversationalists
People who like the same activities
People who share my views
People who stimulate my thinking

48. Politically, which of the following is most important to you?
Economy
Environment
Freedom
Human rights
Opportunity
Peace
Progress
Security
49. I tend to measure my success in life by
Achievements
Assets
Insight
Patience
Promotions
The stability of my primary relationships with others
What I have learned
50. Imagine you have won a vacation for two and you have the choice of the following:

All expense trip to the Hawaii or the Caribbean
A ski trip to the Alps or Sun Valley
A week in New York or London with theater tickets
Environmental tour of the Costa Rican rain forest
Family Vacation in Disneyland or Disney World
Las Vegas for two with show tickets and $500 spending money
National monuments and museums in Washington, D.C. or Paris
Sacred Journey to the Egyptian or Mayan pyramids