Intake Forms

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Intake Forms - It's easy being green when you submit your forms online!

First & Last Name:
Birth Date:
Anniversary Date:
Street Address
City, State, Zip:
Email:
Telephone Number:
What is your occupation?:
How did you hear about Vitality? (Please mention names of people so we can send them a Thank You!):
Do you have any particular skincare concerns or body discomfort that you would like to address during your treatment?
Do you have any special requests regarding the comfort of your treatment? (ie. extra bolstering, no additional heat, allergies, sensitivities, etc.)
Would you be interested in a weekly health news itunes show from Dr.Anne Marie Marcellino of Alive & Well Chiropractic?:
Please type in your 3 letter initials stating that you have read, understand, and agree to all Vital Policies. (Please read the "Vital Policies" page):

(PLEASE SUBMIT THE BELOW FORM IF YOU ARE ADDING AROMATHERAPY TO YOUR TREATMENT)

What's a Dosha?

Ayurveda is simply the pursuit of balance in your life. This system of health care developed in India over 5000 years ago and is health, not disease specific, as it takes into account one's entire personality - body, mind and spirit.

The three doshas are kapha, vata and pitta, and are referred to respectively as the water, air and fire personalities.

Stress, lifestyle, physical environment, relationships and a number of other factors can cause one or more doshas to increase or decrease from their natural levels. The goal of Ayurvedic treatment is to bring back optimal balance of the doshas by restoring your optimal wellbeing.

To find out your Ayurvedic Dosha, try to recognize yourself within these 3 doshas based on how you are feeling right now. This will determine which elements predominate, allowing us to select essential oils that will bring your mind and body into optimum balance.

What's Your Dosha?

Simply enter A, B, or C in the empty box to the right of the questions that best describes you.

SOCIAL DEMEANOR
In a group setting:
A.) I love to chat and be with everyone.
B.) I enjoy taking the lead and organizing.
C.) I’m mellow and easily blend into the mix.

TEMPERAMENT
I tend to love:
A.) Change. I’m very adaptable. B.) Drama. I’m very passionate. C.) Supporting others. I’m very go-with-the-flow.

HAIR TEXTURE
My biggest hair problem is:
A.) Dryness, frizziness and brittle texture.
B.) Fineness, limpness & early graying.
C.) Volume control and oiliness.

SKIN TYPE
My skin tends to be:
A.) Dry, thin or flaky.
B.) Sensitive and prone to irritation.
C.) Oily, moist and prone to breakouts.

BODY TEMPERATURE
I tend to feel:
A.) Cold. My hands and feet are always chilly!
B.) Warm. I keep the window open, even in the winter!
C.) Comfortable. I can adapt to any climate or temperature.

Mostly A’s -YOU’RE A VATA!

Vata is strongly connected to air and space. Your nature is light and quick and your actions fast. All this movement means Vatas tend to feel cold and have dry skin, hair and nails.

Mostly B’s -YOU’RE A PITTA!

Pitta is connected to fire and water. You’re all about smart ideas and letting your emotions out! This “fire” in you needs cooling treatments that keep redness and irritation under control.

Mosly C’s -YOU’RE A KAPHA!

Kapha is related to earth and water. You cherish the sweet moments in life. Your skin tends to be smooth, but sometimes oily, so you need products that rev you up and balance excess oil.

Appointment Hours

Sunday & Monday: By Appointment Only

Tuesday ~ Friday: 9-8pm
Saturday: 9-4pm

Vitality Wellness Spa * 2 Linden St. 2nd Floor * Reading, MA 01867 * 781-942-0098