Vikruti and Lifestyle Quiz

Name *

First Name

Last Name

Kapha Imbalances

Check all the statements that you have been dealing with recently:

Weight Gain

Mucus and phlegm in excess

Colds, coughs, congestions

Having trouble wake up early in the morning

Feeling lethargic and unmotivated

Lonely and withdrawn from social life

Accumulating clutter

Holding on to the past

Feeling full and falling asleep after a meal

Pitta Imbalances

Check all the statements that you have been dealing with recently:

Heartburn and or reflux

Acne

Headaches followed by light sensitivity

Loose stools

Itchy, irritated, or inflamed skin

Feeling overheated, or constant sweating

Irritated and impatient

Other people frustrating you

Feeling jealous

Vata Imbalances

Check all the statements that you have been dealing with recently:

Constipation

Gas, and/or bloating

Dry and flake skin

Being forgetful and/or distracted

Back pain

Poor or irregular appetite

Insomnia, or waking up too early

Irregular menstrual cycle

Anxious worried

What time do you wake up in the morning?

Hour

Minute

Second

AM PM

What time do you go to sleep?

Hour

Minute

Second

AM PM