Your Name:
|
Your e-mail:
|
Characteristics
|
|
Never
|
Mildly
|
Somewhat
|
Mostly
|
Always
|
My mind is very restless/overactive
|
yes
|
yes
|
yes
|
yes
|
yes
|
I am always formulating new ideas & love experimenting with them
|
yes
|
yes
|
yes
|
yes
|
yes
|
I have frequent change of interest /I get bored of one project very soon
|
yes
|
yes
|
yes
|
yes
|
yes
|
I speak quickly & am a very talkative
|
yes
|
yes
|
yes
|
yes
|
yes
|
Under stress, I worry or become anxious/have weak memory
|
yes
|
yes
|
yes
|
yes
|
yes
|
I have low requirement of sleep/insomniac
|
yes
|
yes
|
yes
|
yes
|
yes
|
I am thin and am underweight
|
yes
|
yes
|
yes
|
yes
|
yes
|
My diet is unpredictable; sometimes I am hungry & other times I have to force myself to eat.
|
yes
|
yes
|
yes
|
yes
|
yes
|
Under stress or when traveling, I am likely to have constipation.
|
yes
|
yes
|
yes
|
yes
|
yes
|
My digestion is irregular with gaseous distention & bizarre bowel movements
|
yes
|
yes
|
yes
|
yes
|
yes
|
I have intolerance to cold/have cold hands & feet
|
yes
|
yes
|
yes
|
yes
|
yes
|
My skin & hair are thin, dry or flaky
|
yes
|
yes
|
yes
|
yes
|
yes
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Total (V)
|
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