Designed by the Department of AyurgenomicsPrakriti Analysis Name(Required)Permanent Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry Phone(Required)Email(Required) Age (In Years)(Required)Please enter a number from 1 to 110.Gender(Required) Male Female OthersFather's Name(Required)Mother's Name(Required)Sur Name(Required)Nature of Work(Required) Manual/ Student Professional Exposure to Chemical/RadiationPlace/State/Country of Birth(Required)State/Country of Living(Required)State/Country from where the family Migrated?(Required)Religion(Required) Christianity Hinduism Islam Jainism Judaism Sikhism Zoroastrianism Local Deity AncestorsStatus of Marriage(Required) Different Caste Different Religion Different Region Related None of These Family History of DiseaseAllergy Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinDiabetes Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinEpilepsy Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinHeart Disease Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinHypertension Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinNeuro Disease Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinObesity Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinRespiratory Disorder Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinT.B Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinBreast Cancer Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinColon Cancer Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinLung Cancer Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinOvary/ Prostate Cancer Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinSkin Cancer Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st CousinOther Self Father Mother Brother Sister Wife Son Daughter Mat. Grand Pat. Grand Mat Uncle/ Aunty Mat. 1st Cousin Pat. 1st Cousin 1. Physiological status (PHS)1.01 Status of Appetite Good appetite Stable appetite with usually moderate desire to eat Variable appetite1.02 Dietary/ Eating Habit Enjoys eating, ready to eat in regular interval & Intime Regular food habits, but can spend hours without food Desirous to take food, eats less at a time, needs mid-meals snacksHidden1.01 Status of Appetite (Pita)Hidden1.02 Dietary/ Eating Habit (Pita)1.03 Bowel Habits(Required) Regular, once-a-day, stool well formed, if constipated it is mild (respond to medium strong laxative Regular & frequent, stool semisolid or loose, rarely constipated, (Respond to mild laxatives sometimes even milk, fig, raisins etc.) Variation seen, mostly constipated (Strong purgatives are needed)Hidden1.03 Bowel Habits (Pita)1.04 Sleeping pattern(Required) Sleeping Easily but Light Sleeping easily and Sound (Heavily) Trouble to get sleep, Variable sleep Pattern1.05 Morning feelings, after leaving the bed(Required) Don’t feel fresh Feel fresh. Feel well even with less sleep Feel fresh but not good when have less hours of sleepHidden1.04 Sleeping pattern (Pita)Hidden1.05 Morning feelings, after leaving the bed (Pita)1.06 Dreams(Required) Cool and peaceful dreams, not bothers to remember Passionate dreams, sees heat, light & remembers well Plenty of dreams, mostly related to motion, usually forgets1.07 Physical working capacity/Physical strength(Required) Starts with speed & gets exhausted easily Loves hard work, has moderate capacity Good stamina but slow and not interested for physical workHidden1.06 Dreams (Pita)Hidden1.07 Physical working capacity/Physical strength (Pita)1.08 Performance of activities(Required) Quickly with a lot of initiative Moderately with medium initiative Slow, steady and balance activities1.09 Talking Style(Required) Very fast missing words Sharp, provocative and clear-cut Slow, clear and stableHidden1.08 Performance of activities (Pita)Hidden1.09 Talking Style (Pita)1.10 Walking(Required) Very quick with swift movement Normal and Rhythm Slow and Steady1.11 Menstrual bleeding (For females only)(Required) Scanty Profuse Moderate Not ApplicableHidden1.10 Walking (Pita)Hidden1.11 Menstrual bleeding (For females only) (Pita)1.12 Nature of Thirst(Required) Excessive and frequent, difficult to tolerate Less thirst, easy to tolerate Moderate and variable thirst1.13 Status of Perspiration(Required) Scanty even in hot climate but odorless Profuse with strong odor Moderate perspiration, consistent to climate, with pleasant smellHidden1.12 Nature of Thirst (Pita)Hidden1.13 Status of Perspiration (Pita)1.14 Sexual Qualities(Required) Variable, strong desire, over indulgence & gets exhaust Moderate with dominating behavior Usually low and steady desire, with good stamina1.15 Quantity of seminal discharge (Male Only)(Required) Scanty and comparatively thin in consistency Moderate and normal Plenty and thick Not ApplicableHidden1.14 Sexual Qualities (Pita)Hidden1.15 Quantity of seminal discharge (Male Only) (Pita)1.16 Fertility or productivity(Required) Comparatively lesser Less Capable of producing good no. of offspring’s1.17 Psychic Health in relation to age(Required) Sorrowful Life Average life Happy LifeHidden1.16 Fertility or productivity (Pita)Hidden1.17 Psychic Health in relation to age (Pita)1.18 Resistance to Disease(Required) Usually poor, frequently fall ill Medium Good, able to tolerate seasonal variation, food etc.1.19 Climatic Preference(Required) Prefers warm, avoids cold climate Likes cold, but intolerant to warm/hot Likes normal climate & prefers warm in comparison to coldHidden1.18 Resistance to Disease (Pita)Hidden1.19 Climatic Preference (Pita) 2. MENTAL/PSYCHOLOGICAL STATUS2.01 Mental reaction/Personal traits(Required) Very sensitive, reacts quickly Gets irritated easily & sustains it Cool, Calm, avoids confrontations2.02 Memory status(Required) Remembers easily & tends to forget easily Takes time to grasp, but retains for long Remembers easily and tends to RetainHidden2.01 Mental reaction/Personal traits (Pita)Hidden2.02 Memory status (Pita)2.03 Leadership quality(Required) Don’t like to lead and happy as a follower Requires commanding status Avoid leading2.04 Decision Making Capacity(Required) Takes immediate decision without thinking much Takes decision after properly analyzing the fact Avoid taking decision. Usually keeps them pending.Hidden2.03 Leadership quality (Pita)Hidden2.04 Decision Making Capacity (Pita)2.05 Concentration Power(Required) Very easy to concentrate on a work, but not for long duration Difficult to concentrate on a work Retains concentration for a long period2.06 Attitude towards problems or difficulty(Required) Lot of worrying, instability in reaction Angry, over awed, easily provoked and highly irritable Peaceful, slow, steady and balanceHidden2.05 Concentration Power (Pita)Hidden2.06 Attitude towards problems or difficulty (Pita)2.07 Nature(Required) Easily irritable, irritating to others, exaggerating, anxious materialistic liking Polite but hot-tempered. Proud, brave, bold, less but good friendship Polite, descent, not greedy, appreciating, have good and long lasting friendship.2.08 Liking About Taste(Required) Sweet, salt & sour Sweet, bitter & astringent Pungent, astringent & bitterHidden2.07 Nature (Pita)Hidden2.08 Liking About Taste (Pita) 3. PHYSICAL FEATURES3.01 Body Structure(Required) Thin body height, unusually Medium body built Broad, Compacted body structure3.02 Body Weight(Required) Moderate/Average weight Underweight or Tendency of Fluctuation Overweight or with a tendency to gain weightHidden3.01 Body Structure (Pita)Hidden3.02 Body Weight (Pita)3.03 Distribution of body fat(Required) Unequal/on specific areas Evenly distribution Scanty deposition of body fat3.04 Nature/Texture of skin(Required) Unequal/on specific areas Evenly distribution Scanty deposition of body fatHidden3.03 Distribution of body fat (Pita)Hidden3.04 Nature/Texture of Skin (Pita)3.05 Complexion/skin color(Required) Extremely fair, pinkish Fair, reddish, burns easily Comparatively dull or darkish, tans easily3.06 Body Hair(Required) Dry, rough, coarse, lusterless & curly Soft, scanty, straight, fine textured Thick, shiny, moderateHidden3.05 Complexion/Skin Color (Pita)Hidden3.06 Body Hair (Pita)3.07 Forehead(Required) Large Medium Small3.08 Eyes(Required) Rolling. Restless, small, dull &lusterless Sharp, medium size with sclera of reddish tinge Large calm, stable eyes with milky white scleraHidden3.07 Forehead (Pita)Hidden3.08 Eyes (Pita)3.09 Teeth(Required) Teeth are of average size, yellowish, prone to cavities Dry, cracked, irregular dull white Large, even, gleaming white3.10 Tongue(Required) Thin tongue, with blackish spots, often coated with thin adherent coating Medium, Reddish, occasionally coated with yellow or red coating Thick usually clear, rarely coated, coating is usually thick whiteHidden3.09 Teeth (Pita)Hidden3.10 Tongue (Pita)3.11 Lips(Required) Soft, Moist & Reddish Dry, Thin & Blackish Thick & Glossy3.12 Blood Vessels(Required) Prominent Less Prominent Not visibleHidden3.11 Lips (Pita)Hidden3.12 Blood Vessels (Pita)3.13 Scalp Hair(Required) Dark I shade, coarse, rough, and easily prone to dandruff and split ends. Thin, delicate, straight, light colored, turn grey at an early age Strong, thick, dark, slightly wavy with good lusture, oiliness is usually one of the chief complaints3.14 Joint(Required) Crackling joints, hyper mobile in nature Comparatively normal but have soft and loose ligaments Well lubricated, strongly built joints which are well organized, well coveredHidden3.13 Scalp Hair (Pita)Hidden3.14 Joint (Pita)3.15 Voice(Required) Rough unclear voice, which turns hoarse or cracks on strain Concise, sharp voice, intense in nature & high pitched Deep, pleasant, resonant voice which is melodious, resonating but lower in pitch and intensity3.16 Nail(Required) Hard, brittle, rough & differ in size from ne one another, bluish/grayish in color Soft, strong, well formed, lustrous, pink in color Strong, large thick symmetrical & somewhat pale in colorHidden3.15 Voice (Pita)Hidden3.16 Nail (Pita)3.17 Body Temperature(Required) Feels slightly cold on touch Feels slightly warm on touch Normal3.18 Shape of Palms and Feet(Required) Short and broad Medium and slim Long and broadHidden3.17 Body Temperature (Pita)Hidden3.18 Shape of Palms and Feet (Pita)3.19 Face(Required) Small and broad with uneven features Medium & oval with sharply defined features Round, babbly and attractive with balance featuresHidden3.19 Face (Pita) 4. Social or Economic Status4.01 Economy(Required) Getting less outcome with hard work Getting good outcome with moderate efforts Enjoys lavishly and royal lifeHidden4.01 Economy (Pita) 5. Assessment of Prakriti in GeneralBody Build(Required) Lean Medium Well – BuiltSkin(Required) Dryness More Moles/Freckles More Moles/FrecklesHairs(Required) Rough Scanty, Gray, Balding Plenteous, CurlyComplexion(Required) Dull, Darkish Fair, Ruddy Whitish (Pale)HiddenBody Build (Pita)HiddenSkin (Pita)HiddenHairs (Pita)HiddenComplexion (Pita)Tendons & Veins(Required) Prominent Normal Well CoveredBody Movements(Required) Rapid & Unsteady Normal LessGait(Required) Rapid & Unsteady Normal Steady & FirmPhysical Exertion(Required) Poor Endurance Medium Good EnduranceHiddenTendons & Veins (Pita)HiddenBody Movements (Pita)HiddenGait (Pita)HiddenPhysical Exertion (Pita)Resistance to Disease(Required) Poor Medium GoodHunger / Appetite(Required) Variable Strong, Sharp Constant, Less.Quantity of Food(Required) Variable Large SmallHabit of Taking Food(Required) Fast Frequent SlowHiddenResistance to Disease (Pita)HiddenHunger / Appetite (Pita)HiddenQuantity of Food (Pita)HiddenHabit of Taking Food (Pita)Perspiration(Required) Not Specific Profuse, Bad Smell Constant, LessMemory(Required) Short-Term Average Long TermIntolerance to(Required) Cold Hot Not SpecificInitiation to start any work(Required) Very Quickly Medium Speed SlowlyHiddenPerspiration (Pita)HiddenMemory (Pita)HiddenIntolerance to (Pita)HiddenInitiation to start any work (Pita)Perception(Required) Very Quickly Medium Speed SlowlyExcitement in response to different matters(Required) Very Quickly Quick SlowlySpeech(Required) Quick, Talkative, Inconsistent Argumentative, Convincing Slow Definite, Not TalkativeCompetitive Capacity(Required) Don’t Like Competitive Pressure Excellent Competitor Handle Competitive Stress EasilyHiddenPerception (Pita)HiddenExcitement in response to different matters (Pita)HiddenSpeech (Pita)HiddenCompetitive Capacity (Pita)Mood(Required) Change Quickly Change Slowly Steady, UnchangeableHiddenVataHiddenPittaHiddenKaphaHiddenMood (Pita)HiddenPercentage of VataHiddenPercentage of PittaHiddenPercentage of Kapha Thank You So much for using this Prakriti Assessment form maintained by Department of Ayur Genomics - Sri Sri College of Ayurvedic Science & Research Hospital, Sri Sri University, Cuttack. Please submit the form to view your result.