So that I can learn a little more about you and your needs,

please fill out the below form in preparation for our initial consult.

If you have any questions about any of the fields, you can leave them empty, and we can go over them when we meet.

Thank you for your time. I look forward to working with you!

In good health,

Mary

Name *
Name
Phone *
Phone
What's your birthdate?
What's your birthdate?
How did you hear about me? *
What brings you here? *
Please select all that apply
Do you live in the NYC area *
IF YOU ARE SEEKING PREGNANCY + OR POSTPARTUM SUPPORT PLEASE FILL OUT THE FEILD BELOW
What is your EDD?
What is your EDD?
Have you decided on your birth place + practice?
Is this your first baby?
Do you know what a Doula is?
Have you taken or are you enrolled in a Childbirth Ed course?
IF YOU ARE HERE FOR MEAL PLANS + OR HEALTH COACHING PLEASE FILL OUT THE FIELDS BELOW
WHAT IS YOUR AYURVEDIC CONSTITUTION?
Your unique Ayurvedic constitution is made up of the mental, behavioral, emotional, and physical elements that you most identify with at the core. In Ayurveda, the term “Dosha” is used to identify imbalances where they exist within your constitution. By knowing your specific constitution, and or Doshic disposition, you will gain more insight into what aggravates you physically and mentally, as well as how to prevent these aggravations and then maintain optimal health. The mind-body practices used in Ayurveda can improve your stress levels, aid in healthy digestion, and provide you with a youthful glow. These nurturing practices include such things as eating a balanced diet, seasonal cleansing, both dietary and within your environment, yoga, exercise, meditation, massage, and the use of herbs and aromatherapy
THE THREE DOSHA'S
VATA is composed of elements, space, and air. It governs our movement, communication, and nervous system. Vata qualities are light, clear, moving, cold, rough, brittle and small. When out of balance it can cause, dryness, respiratory issues, poor circulation and mood disorders. Vata season is from the fall to early winter. PITTA is composed of the elements of fire and water. It governs our energy, digestion, and metabolism. Pitta qualities are hot, sharp, fluid, greasy, acidic, sour, pungent, light. When out of balance it can cause, autoimmune reactions, rashes, redness, irritations, inflammation, and infection. Pitta season is from late spring to early fall. KAPHA is composed of the elements of water and earth. It governs our structure. It is the ‘glue’ that holds us together. Kapha qualities are slow, steady, stable, sweet, soft, sticky, cold, heavy and dull. When out of balance it can cause excess mucus, congestion, coughs, colds, swelling and water retention. Kapha season is from the winter to early spring. In the below fields please mark one or as many as two descriptions along each row, choose ones that best describe you and how you have been most of your life. You want to identify those characteristics that you were born with. This will help in identifying your constitution. When you are done hit submit, and I will follow up with you about your unique constitution and ways to work with it.
What's your physical frame?
Select up to two options that best describes the way you've been most of your life.
What's your weight?
Select up to two options that best describes the way you've been most of your life.
How much hair do you have?
Select up to two options that best describes the way you've been most of your life.
What's your hair texture like?
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What's your hair color?
Select up to two options that best describes the way you've been most of your life.
What's your skin like?
Select up to two options that best describes the way you've been most of your life.
What's your complexion like?
Select up to two options that best describes the way you've been most of your life.
What are your teeth like?
Select up to two options that best describes the way you've been most of your life.
What is your nose like?
Select up to two options that best describes the way you've been most of your life.
What are your eyes like?
Select up to two options that best describes the way you've been most of your life.
What are your nails like?
Select up to two options that best describes the way you've been most of your life.
What are your joints like?
Select up to two options that best describes the way you've been most of your life.
What's your digestion like?
Select up to two options that best describes the way you've been most of your life.
What's your usual elimination?
Select up to two options that best describes the way you've been most of your life.
How often do you sweat?
Select up to two options that best describes the way you've been most of your life.
What's your mental activity like?
Select up to two options that best describes the way you've been most of your life.
What's your memory like?
Select up to two options that best describes the way you've been most of your life.
What's your intellect like?
Select up to two options that best describes the way you've been most of your life.
What are your dreams like?
Select up to two options that best describes the way you've been most of your life.
How's your sleep?
Select up to two options that best describes the way you've been most of your life.
What's your speech like?
Select up to two options that best describes the way you've been most of your life.
How are your emotions + moods?
Select up to two options that best describes the way you've been most of your life.
How's your confidence?
Select up to two options that best describes the way you've been most of your life.
What are your relationships like?
Select up to two options that best describes the way you've been most of your life.
When threatened you tend to?
Select up to two options that best describes the way you've been most of your life.
What's your sex drive like?
Select up to two options that best describes the way you've been most of your life.
What's your physical activity like?
Select up to two options that best describes the way you've been most of your life.
What's your relationship to routine?
How's your appetite?
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How fast do you eat?
Select up to two options that best describes the way you've been most of your life.
What temperature do prefer your food + drinks?
Select up to two options that best describes the way you've been most of your life.
What is your ideal weather?
Select up to two options that best describes the way you've been most of your life.
How do you manage your finances?
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How charitable are you?
Select up to two options that best describes the way you've been most of your life.