From The 3-Season Diet by John Douillard, DC

Childs Name:
Parent/Guardian Name:

Date:

Complete on a Computer
1.
2.

3.

4.

5.
6.

7.

Complete Handwritten

Save this form to your computer.

For each category, check the boxes next to the
options that best describe your child recently
within the past few weeks.
Read across the page from left to right. For
example, for the category Mental activity
check quick mind, restless.
If you feel your child can equally relate to more
than one of the descriptions, check all that
apply.
After finishing a profile, the form will
automatically tally up your choices.
After finishing the profiles, the form will have
automatically populated the profile totals for
the Totals Chart on page 4.
Note the column where your child has the most
points and then find the corresponding Body
Type. You can read about the different Body
Type on the last page of this questionnaire.

1.
2.

3.

4.

5.

6.
7.

Print out this form.

For each category, check the boxes next to the
options that best describe your child recently
within the past few weeks.
Read across the page from left to right. For
example, for the category Mental activity check quick mind, restless.
If you feel your child can equally relate to more
than one of the descriptions, check all that
apply.
After finishing a profile, for each column, tally
up how many descriptions you checked. This
number goes into the Subtotal row at the
bottom of each profile.
After finishing the profiles, please record your
profile totals for the Totals Chart on page 4.
Note the column your child has the most points
and then find the corresponding Body Type. You
can read about the different Body Type on the
last page of this questionnaire.

MENTAL PROFILE
Category
Mental activity

WINTER / VATA
Quick mind, restless

Memory
Thoughts
Concentration

Short-term best
Constantly changing
Short-term focus best

Ability to learn

Quick grasp of learning

Dreams

Fearful, flying, running,

jumping
Interrupted, light
Fast, sometimes missing
words
High pitch

Sleep
Speech
Voice
Mental subtotal:

6662 Gunpark Drive, Suite 102

Boulder, CO 80301

SUMMER / PITTA
Sharp intellect,
aggressive
Good general memory
Fairly steady
Better than average
mental concentration
Medium to moderate
grasp
Angry, fiery, violent,
adventurous
Sound, medium
Fast, sharp, clear-cut

SPRING / KAPHA
Calm, steady, stable

Medium pitch

Low pitch

________
0

________
0

2008-2014

Long-term best
Steady, stable, fixed
Good ability for longterm focus
Slow to learn new things
Include water, clouds,
relationships, romance
Sound, heavy, long
Slow, clear, sweet

________
0

Phone: 303.516.4848, Fax: 303.530.4409

admin@lifespa.com, LifeSpa.com

BEHAVIORAL PROFILE
Category
Eating speed
Hunger level

WINTER / VATA
Quick
Irregular

Food and drink

Achieving goals
Giving/sharing

Prefers warm
Easily distracted
Gives small amounts

Works best
Weather preference
Reaction to stress
Piggy Bank

While supervised
Aversion to cold
Excites quickly
Doesnt save, spends
quickly
Tends toward shortterm friendships, makes
friends quickly

Friendships

Behavioral subtotal:

SUMMER / PITTA
Medium
Sharp, needs food when
hungry
Prefers cold
Focused and driven
Gives nothing, or large
amounts infrequently
Alone
Aversion to heat
Medium
Saves, but big spender
Tends to be a loner,
friends related to school

________
0

SPRING / KAPHA
Slow
Can easily miss meals
Prefers dry and warm
Slow and steady
Gives regularly and
generously
In groups
Aversion to damp, cool
Slow to get excited
Saves regularly,
accumulates wealth
Tends to form longlasting friendships

________
0

________
0

EMOTIONAL PROFILE
Category
Moods
Reacts to stress with
More sensitive to
When threatened,
tends to
Relationship with
parents
Expresses affection
When feeling hurt
Emotional trauma
causes
Confidence level

WINTER / VATA
Change quickly
Fear
Own feelings
Run

SUMMER / PITTA
Change slowly
Anger
Not sensitive
Fight

SPRING / KAPHA
Steady, unchanging
Indifference
Others feelings
Make peace

Clingy

Jealous

Secure

With words
Cries
Anxiety

With gifts or actions

Argues
Denial

With touch
Withdraws
Depression

Timid

Outwardly selfconfident
________

Inner confidence

Emotional subtotal:

6662 Gunpark Drive, Suite 102

Boulder, CO 80301

________

________

Phone: 303.516.4848, Fax: 303.530.4409

info@lifespa.com, www.lifespa.com

PHYSICAL PROFILE
Amount of hair
Hair type
Hair color
Skin
Skin temperature
Complexion
Eyes
Whites of eyes
Size of teeth
Weight
Elimination

WINTER / VATA
Thin (more coarse)
Dry
Light brown, blonde
Dry, rough, or both
Cold hands/feet
Darker
Small
Blue/brown
Very large or very small
Thin, hard to gain
Dry, hard, thin, easily
constipated

SUMMER / PITTA
Thin-Average (more curly)
Normal
Red, auburn
Soft, normal to oily
Warm
Pink-red
Medium
Yellow or red
Small-medium
Medium
Many during day, soft to
normal

SPRING / KAPHA
Thick
Oily
Dark brown, black
Oily, moist, cool
Cool
Pale-white
Large
Glossy white
Medium-large
Heavy, gains easily
Heavy, slow, thick, regular

Physical subtotal:

________

________

________

Exercise tolerance
Endurance
Strength
Speed
Competition
Walking speed
Muscle tone
Runs like
Body size
Reaction time

FITNESS PROFILE
WINTER / VATA
SUMMER / PITTA
Low
Medium
Fair
Good
Fair
Better than average
Very good
Good
Doesnt like competitive Driven competitor
pressure
Fast
Average
Lean, low body fat
Medium, with good
definition
Deer
Tiger
Small frame, lean or
Medium frame
long
Quick
Average

Fitness subtotal:

6662 Gunpark Drive, Suite 102

Boulder, CO 80301

________

________

SPRING / KAPHA
High
Excellent
Excellent
Not so fast
Deals easily with
competitive pressure
Slow and steady
Brawny/bulky, with higher
fat percentage
Bear
Large frame, fleshy
Slow
________

Phone: 303.516.4848, Fax: 303.530.4409

info@lifespa.com, www.lifespa.com

Childs Name:

Date:

Parents/Guardians Name:
TOTALS
Your Primary Body Type is the column you scored highest in.
Profile

WINTER / VATA

SUMMER / PITTA

SPRING / KAPHA

Mental

Emotional

Physical

Fitness

0
________

0
________

Behavioral

TOTAL:

6662 Gunpark Drive, Suite 102

Boulder, CO 80301

________

Phone: 303.516.4848, Fax: 303.530.4409

info@lifespa.com, www.lifespa.com

FOR YOUR USE AND REFERENCE

Vata- Winter

Pitta- Summer

Kapha- Spring

Governs

Nervous System

Digestion

Structure

Season

Winter

Summer

Spring

Time of Day

2:00-6:00 a.m.:
2:00-6:00 p.m.:

Wake Up
Think

10:00 am - 2:00pm:
10:00pm - 2:00am:

Digest
Cleanse

6:00-10:00 a.m. :
6:00-10:00 p.m.:

Exercise
Sleep

Taste/Qualities
Aggravating

Pungent, Bitter, Astringent/

Light, Cold, Dry

Pungent, Sour, Salty/

Hot, Light, Dry

Sweet, Sour, Salty/

Heavy, Oily, Cold

Taste/Qualities
Balancing

Sweet, Sour, Salty/

Heavy, Oily, Hot

Sweet, Bitter, Astringent/

Cold, Heavy, Oily

Pungent, Bitter, Astringent/

Light, Dry, Hot

Beneficial Oils

Sesame, Almond, Apricot

Sesame, Coconut, Sunflower

Sesame, Olive

WINTER- VATA: Air

Vata is the most important of the three doshas. If left unbalanced it causes Pitta and Kapha to become
imbalanced. Vata is the main driver or mover of the body, providing these functions:
All eliminations: fetus, semen, feces, urine, and sweat.
Assists with metabolisms in the body (Agni), transformation of tissues.
Controls movement in body (mental and physical) such as respiration, heartbeat, motivation,
contraction of muscles, and natural urges.
Relays all sensory input to the brain, motor functions.
Governs nervous system.

SUMMER- PITTA: Fire

Wherever there is transformation, there is Pitta. Pitta provides the following functions:
Metabolism, from digestion of food to transformation of all other material.
Thermogenesis maintains the proper body temperature.
Vision.
Comprehension of information into knowledge / reasoning and judgment.
Complexion gives color and softness to skin.

SPRING- KAPHA: Earth, Water

Kapha is the heaviest of the three doshas. It provides the structures and the lubrication that the body
needs. Kapha provides the following functions:
Strength and energy.
Moistness & Lubrication.
Stability to add the necessary grounding aspect to both mind and body.
Mass and structure to provide fullness to bodily tissues.
Fertility & Virility.
6662 Gunpark Drive, Suite 102
Boulder, CO 80301

Phone: 303.516.4848, Fax: 303.530.4409

info@lifespa.com, www.lifespa.com