Name
*
First Name
Last Name
Email
*
What's your birthdate?
MM
DD
YYYY
What's your birth time?
Hour
Minute
Second
AM
PM
In what country, city, state were you born?
What's your physical frame?
Select up to two options that best describes the way you've been most of your life.
thin, lanky, slender
medium, symmetrical build, athletic
larger, round, stocky
What's your weight?
Select up to two options that best describes the way you've been most of your life.
thin, hard to gain
medium
heavy, easy to gain
How much hair do you have?
Select up to two options that best describes the way you've been most of your life.
average
thinning + bald
thick
What's your hair color?
Select up to two options that best describes the way you've been most of your life.
light brown, blond
auburn, reddish, early greying
dark brown, black
What's your hair texture like?
Select up to two options that best describes the way you've been most of your life.
dry, frizzy, thin
straight + fine
oily, wavy, thick
What's your skin texture like?
Select up to two options that best describes the way you've been most of your life.
dry, rough, cold
soft, normal to oily, warm
oily, moist
What's your complexion like?
Select up to two options that best describes the way you've been most of your life.
darker, tans easily
pink, red, sunburns easily
pale
What are your teeth like?
Select up to two options that best describes the way you've been most of your life.
large, thin gums
small, medium, tender gums
healthy strong gums, white
What is your nose like?
Select up to two options that best describes the way you've been most of your life.
uneven, deviated septum
long, pointed, red nose tip
short, rounded, button
What are your eyes like?
Select up to two options that best describes the way you've been most of your life.
small, brown, nervous, active
medium, green, hazel, sharp
big, dark, blue, clear, calm
What are your nails like?
Select up to two options that best describes the way you've been most of your life.
dry, brittle, break easily
sharp, flexible, pink, shiny
thick + smooth
What are your joints like?
Select up to two options that best describes the way you've been most of your life.
thin, stiff, crack
loose + flexible
large + cushioned
What's your digestion like?
Select up to two options that best describes the way you've been most of your life.
gas, bloating, constipation
quick, heartburn, acid reflux
indigestion
What's your usual elimination?
Select up to two options that best describes the way you've been most of your life.
dry, hard, constipated
many, loose, normal
heavy, thick, slow, regular
How often do you sweat?
Select up to two options that best describes the way you've been most of your life.
rarely
frequently
moderately
What's your mental activity like?
Select up to two options that best describes the way you've been most of your life.
quick, restless, active
sharp, critical, aggressive
calm, steady, slow, stable
What's your memory like?
Select up to two options that best describes the way you've been most of your life.
good near + poor distant
distinct + sharp
slow + sustained
What's your intellect like?
Select up to two options that best describes the way you've been most of your life.
distracted, quick, faulty
focused + accurate
slow, steady, exact
What are your dreams like?
Select up to two options that best describes the way you've been most of your life.
fearful, active, quick, flying
aggressive, heated, adventurous
watery, romantic, relationships
How's your sleep?
Select up to two options that best describes the way you've been most of your life.
light + interrupted
little but sound, medium
sound, deep, long
What's your speech like?
Select up to two options that best describes the way you've been most of your life.
quick + can miss words
sharp, direct, strong
slow, clear, monotonous
How are your emotions + moods?
Select up to two options that best describes the way you've been most of your life.
fearfull, anxious, flexible, indecisive
anger, denial, determined, jealous
calm, depressed, attached
How's your confidence?
Select up to two options that best describes the way you've been most of your life.
shy + timid
outwardly self-confident
inner confidence
What are your relationships like?
Select up to two options that best describes the way you've been most of your life.
many, casual, clingy
intense + jealous
long, deep, secure
When threatened you tend to?
Select up to two options that best describes the way you've been most of your life.
run
fight
make peace
What's your sex drive like?
Select up to two options that best describes the way you've been most of your life.
variable + low
moderate
strong
What's your physical activity like?
Select up to two options that best describes the way you've been most of your life.
hyperactive
good + athletic
lacking + sedentary
What's your relationship to routine?
dislike routine
eager to plan + organize
prefer a routine
How's your appetite?
Select up to two options that best describes the way you've been most of your life.
irregular
sharp + strong
slow + steady
How fast do you eat?
Select up to two options that best describes the way you've been most of your life.
fast
medium
slow
What temperature do prefer your food + drinks?
Select up to two options that best describes the way you've been most of your life.
warm
cold
What is your ideal weather?
Select up to two options that best describes the way you've been most of your life.
warm + moist
cool + dry
warm + dry
How do you manage your finances?
Select up to two options that best describes the way you've been most of your life.
doesn't save + spends a lot
saves + spends a lot
saves + accumulates wealth
How charitable are you?
Select up to two options that best describes the way you've been most of your life.
donates small amounts
rarely or never donate
regular giver + very generous
Any additional comments?