Date Name Treatment Email Contact Therapist Which best describes your skin? - Tends to be dry and always needs to be moisturized- My skin is fairly thick (may be prone to acne)- Tends to be sensitive, warm, reddish, inflamed, and/or oily Which best describes your build? - I am small-boned with a thin build and prominent joints- I am of medium build and have a fairly well-balanced body- I have a solid, ample or stocky build with larger bone structure. Which best describes your appetite I have a hearty appetite and digest food quickly. I can get irritable if I miss a meal or can’t eat when I'm hungryMy appetite is irregular, sometimes I'm hungry and other times I'm notI tend to feel heavy after eating and have a sluggish digestion. Which best describes your memory? - I'm good at picking up new things but my long-term memory is poor- Good- Slow but once I remember something it tends to stick Which best describes your sleep? - I'm a light sleeper- I sleep well- I'm a heavy, sound sleeper Which best describes you? - I don't like the cold. I prefer warm food and drinks- I don't like heat. It makes me tired and I perspire easily- I don't like humid or damp environments Which best describes how you react to stress? - It makes me angry, frustrated, and/or irritable- It makes me anxious, fearful, and/or insecure- I'm fairly calm under stress. However, I tend toavoid difficult situations Which best describes you? - It's relatively hard for me to put on weight- I put on weight like most people- I gain weight easily and find it hard to lose Which best describes you? - Creative, enthusiastic, active, and somewhat restless- Determined, impatient, critical, stubborn, and easy to anger- Even-tempered, patient, compassionate, and not particularlyhigh-energy Which best describes your bowel movements? - Irregular, hard, dry- Easy, regular, soft, loose- Thick, heavy, slow Which best describes the kind of illnesses you are susceptible to? - Congestion, water retention, cystic acne, and/or lethargy- Inflammation, hypertension, hypersensitivity (allergies, rashes, arthritis, etc) and/or aggression- Constipation, anxiety, nervousness, and/or insomnia Do you suffer any allergy to any of the following? Ginger Milk Lime Cucumber Avocado Other Any area of your body that we should concentrate on? Head Hand Face Feet Shoulder Thigh Neck Lower back Leg Other Submit
