Mind Body Questionnaire

Section 1

Choose which statement best describes you.

Frame
I am thin, lanky and slender with prominent joints and thin muscles.I have a medium,symmetrical build with good muscle development.I have a large, round or stocky build. My frame is broad, stout or thick.

Weight
LOW; I may forget to eat or have a tendency to lose weight.MODERATE; it is easy for me to gain or lose weight if I put my mind to it.HEAVY; I gain weight easily and have difficulty losing it.

Eyes
My eyes are small & active.I have a penetrating gaze.I have large pleasant eyes.

Complexion
My skin is dry, rough or thin.My skin is warm, reddish in color and prone to irritation.My skin is thick, moist and smooth.

Hair
My hair is dry, brittle or frizzy.My hair is fine with a tendency towards early thinning or graying.I have abundant, thick and oily hair.

Joints
My joints are thin and prominent and have a tendency to crack.My joints are lose and flexible.My joints are large, well knit and padded.

Sleep Pattern
I am a light sleeper with a tendency to awaken easily.I am a moderately sound sleeper, usually needing less than eight hours to feel rested.My sleep is deep and long. I tend to awaken slowly in the morning.

Body Temperature
My hands and feet are usually cold and I prefer warm environments.I am usually warm, regardless of the season, & prefer cooler environments.I am adaptable to most temperatures but do not like cold, wet days.

Temperament
I am lively and enthusiastic by nature. I like to change.I am purposeful and intense. I like to convince.I am easy going and accepting. I like to support.

Under Stress...
I become anxious and/or worried.I become irritable and/or aggressive.I become withdrawn and/or reclusive.

Section 2

Using the following scale, indicate how well each statement applies to your life experiences over the past thirty to sixty days .