Constitutional Assessment Form
Evaluate your general physical condition and constitutional tendencies. Please answer the following questions as accurately as possible.
Full Name
First Name
Last Name
Age
How would you describe your general energy level?
Low
Moderate
High
How often do you feel physically comfortable throughout the day?
Rows
Never
Rarely
Sometimes
Often
Always
Physical comfort
1
2
3
4
5
Mental clarity
6
7
8
9
10
How would you rate your overall physical resilience?
1
2
3
4
5
Which best describes your body frame?
Slender
Medium
Broad
Other
How do you usually respond to changes in weather?
Sensitive to changes
Adapt easily
No noticeable response
Describe your general appetite.
Low
Moderate
High
Varies
How would you describe your sleep patterns?
Restful and consistent
Light or easily disturbed
Irregular
Additional comments or observations (optional)
Submit Assessment
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