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Please Provide Information About Your Symptoms

Symptom 1

Timing of Symptom

Severity

Mild
Moderate
Severe

Symptom 2

Timing of Symptom

Severity

Mild
Moderate
Severe

Symptom 3

Timing of Symptom

Severity

Mild
Moderate
Severe

Please list any additional symptoms or diagnosis

Do you have any known allergies; herbs, food, etc.? If so, please list below

Which types of products would you prefer?

Tea
Tincture
Powdered Herbs
Honey Paste (powdered herbs in honey)
Topical Remedy

herbs, any prefer?

Constitution Questions. Check all that apply.

I experience cold hands and feet
I sweat easily
I have dry, brittle hair, skin or nails
I am prone to nervousness, restlessness or worry
My body temperature is consistanty warm
My appetite is strong
I am prone to inflammation
My digestion is slow
I am prone to lethargy
I am prone to anger, irritation or intensity
I don’t tolerate hot weather
I don’t tolerate windy conditions
I don’t tolerate cold weather
I have moist, oily skin
I am prone to swelling, puffiness or stagnation
My appetite is inconsistant
If I miss a meal, I get hangry (irritated)
I experience gas, bloating or heartburn regularly
I feel sleepy after meals
I prefer raw foods
I prefer warm, cooked foods
I have steady energy all day
I have energy spikes or inconsistant energy
I am fatigued most days
I am a light sleeper
I often wake in the night too hot or thirsty
I could sleep all the time, I love it and it is easy to do
I have a thinner build
I have a fuller, thicker body type
I have a muscular build
I gain and lose weight easily
I have a hard time losing weight
I don’t gain weight easily
I prefer stillness
I prefer action and movement
I wake feeling rested
I tire easily
My favorite season is Winter
My favorite season is Summer
My favorite season is Spring
My favorite season is Autumn
I stay calm in stressful situations
I adapt easily to changes
I feel most energized in the morning when I get up
I feel most energized midday
I feel most energized in the evening
I shutdown in stressful situations
I get anxious easily
I enjoy spicy foods
I like oily and creamy foods
I like satly, crunchy foods
I like sweets

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