Constitutional Assessment Form

Constitutional Assessment Form
Evaluate your general physical condition and constitutional tendencies. Please answer the following questions as accurately as possible.
Full Name
First NameLast Name
Age
How would you describe your general energy level?
How often do you feel physically comfortable throughout the day?
Rows Never Rarely Sometimes Often Always
Physical comfort
Mental clarity
How would you rate your overall physical resilience?
Which best describes your body frame?
Other
How do you usually respond to changes in weather?
Describe your general appetite.
How would you describe your sleep patterns?
Additional comments or observations (optional)
Should be Empty:

Select theme:

Rows	Never	Rarely	Sometimes	Often	Always
Physical comfort
Mental clarity