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Assessment Form

This confidential assessment helps us understand your unique constitution and current health status from an Ayurvedic perspective. Your responses will help create a personalized wellness plan. (Estimated time: 5 minutes)

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Question 1: Age Group

Question 2: What is your primary concern regarding sexual wellness?

Question 3: How would you describe your body type?

Question 4: How is your current energy level throughout the day?

Question 5: How would you rate your sleep quality over the past month?

Question 6: How regular is your digestive system?

Question 7: What is your current stress level?

Question 8: How would you describe your sexual desire/libido compared to 6 months ago?

Question 9: Do you experience any of these symptoms regularly?

Question 10: How often do you exercise or engage in physical activity?

Question 11: What describes your diet pattern best?

Question 12: Do you consume any of the following regularly?

Question 13: Which statement best describes your emotional state lately?

Question 14: How many hours of screen time (phone/computer/TV) do you have daily?

Question 15: Have you tried any treatments for sexual wellness before?

Optional: Gender (for personalized recommendations)

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