Beautiful Services ~ Intake Form
The Ancient wisdom of Ayurveda gives us a language that unites the spirit of Nature and the human body. The elements of Earth, Fire, Water, Air and Space (the 5 great elements) are found in all living things, including us. The practice is to keep these elements in balance. When they are, our skin, our body and mental disposition is healthy, radiant and alive.   This brief quiz will give us an idea of where we can begin to shift some lifestyle practices.  Please answer all the questions below, and indicate by selecting the best answer that closely describes you.
Let us begin...
What is your name, email address, and phone number? *

Please enter email AND phone information so I can get in touch to schedule our session.
I would describe my skin as... *

My skin when in stress mode (imbalanced) shows... *

I would describe my body as... *

My hair is best described as... *

Under stress I become... *

How well do you sleep? *

In general my memory is best described as... *

How would you best describe your mental activity? *

My energy level is... *

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