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Consultation Clinic Printout
1. What is your constitution?
Elements In Universe and Life
Attributes and geometrical shapes of
elements are permanent. It is important to
understanding the ‘type’ and engaging it wisely.
Ether Air Fire Water Earth
Wisdom Mobility Transformation Attraction Integrity
Bliss, stillness Rhythm Heat Fluidity Stability
Tranquility Cycles Intensity Bond Solidity
Calmness Lightness Precision Flexibility Gravity
My Permanent Body Constitution
What’s the shape of your body when you are/were healthy?
Ether Air Fire Water Earth
Tall Small Angular Soft Solid
Delicate Short Triangular Rounded Rectangular
Slender Light Muscular Curvaceous Heavy bones
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My current Physical Excess
imbalance can occur to any body type.
use or abuse of “elements of life”. Any
Most imbalances are due to overuse, under
Ether Air Fire Water Earth
Depletion Irregular Over heated Sluggish Rigidity
Loss Improper, twists Acidity Mucusy Clot
Thinning Aches, pain Redness Weight gain Growth
Waning Dehydrated Burning Excess fluid Spur
My current Psychological Excess
Ether Air Fire Water Earth
Absence Fluctuating, shifty Irritable Clingy Stubbornness
Loss Mental blockage Easily angered Sluggish Inflexibility
Irrational Confusion, worry Easily impatient Greedy Overpowering
Anxiety Insecurity, fear Frustration Procrastination Rigidity
2. I am designed to ...
Ether Air Fire Water Earth
Creative Adaptable Analytic Listener Structured
Meditator Multitasking Driven Carer Methodical
Open Easy going Challenging Gentle Hands on
Charitable Communicator Competitive Tolerant Routine lover
Philosopher Dancer Result oriented Nurturer Supervisor
Scientist Teacher Precise Parental Administrator
Thinker Musician Sharp, intense Chef Manager
Dreamer Performer Marketer Nurse Coach/ Trainer
Based on the body shape, when I am healthy:
My permanent body type is predominant in …………… …………… ……………
My current work is …………… …………… ……………
My current lifestyle is …………… …………… ……………
My current relationship is …………… …………… ……………
I know using non constitutional elements need to done carefully
I need to introduce more (diet) …………… …………… ……………
I need to introduce more (exercise) …………… …………… ……………
I need to introduce more (lifestyle) …………… …………… ……………
Elements and life
Categories Ether Air Fire Water Earth
Exercise Meditation Aligning Cardio Stretch Toning
Awareness Breathing Sprinting Yoga (asana) Weights
Nutrition Philosophy Fiber Digestives Carbs, fats Protein
Fasting Freshness Metabolic Essential fats Minerals
Room Spacious, Everything, Efficiently organised Convenient, Brick walls,
uncluttered everywhere accessible timber floors
Tools, Minimal All shapes, sizes, Most efficient, Comfort items, food, Lasting, reliable,
furniture variety fastest, latest cushions strong
Vacation Meditation retreat Surprise me, Competitive, Water side, food, Physical, getting
unpredictable challenging friends, cushions hands dirty
Silent, wilderness Something totally Mountain biking, Pampering, yoga Outback, gardening,
outrageous white water rafting retreat renovation
Olympic High jumpers Marathoners Sprinters Gymnasts Weight lifters
Which
vehicle is
the best?
3. Ayurvedic Tongue Analysis | Ayurveda Elements | 02 9904 7754
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Copyrighted to Ayurveda Elements 2005
4.
5. My current health status
after being on the ayurvedic program for a month is as follows.
Fill in the blanks if applicable.
1. The easiest part of the program is
2. The most difficult part of the program is
3. The most satisfying part of the program is
4. I need more clarifications on
5. I couldn’t do this
6. I followed the new nutrition program about ……% perfectly
7. I followed the new cleansing about ……% regularly
8. I followed the new practices about ……% perfectly
9. My exercise was ……% regular/perfect
10. I took the medicines about ……% regularity
11. The amount of medicines yet to be finished is ……% in quantity
12. Overall I followed the advise about ……% perfectly
13. My energy feels better by ……%
14. Being on the program, I wake up refreshed by ……%
15. Being on the program, my mental clarity is better by ……%
16. Overall I am better by ……%
17. I feel definite the improvement in the following area
18. The problems still to be improved is/are
19. New problems are
6. Here is how I am going to do
My Ayurvedic health program…
It will be planned and systematic.
Program My order Week/day Time
• Herbs Daily As directed
• Shopping Week Day
• Low impact cardio Weekly 1-2-3 times … hours weekly
• Cooking Frequency Time
• Yoga Weekly 1-2-3 times … hours weekly
• Meditation Daily At bedtime
• Cleansing First one Second one
Once they are scheduled,
I know it is easy to do them.
Total health is my goal.
…………………………………………………………………………
Here is my signature.
And this is my promise to myself.