Authentic Ayurveda Kitcheri Program

You will receive an email from Natalie within 24 hours of form completion with your confirmed start date and other program details.

First name

Last name

Email

List your top 3 preferred start dates. (Must be a date outside of your menstrual period. Best to choose dates where you can be less active and allow more rest).

Are you currently taking any medications or supplements that affect your stool (e.g. Magnesium, stool softener or binder)? If yes, list them here. (N/A if none)

What are you currently drinking daily? How much? List any coffee, tea, cacao, alcohol, etc.

List any food allergies or sensitivites here. (N/A if none)

Elemental (Dosha) Quiz to Inform Your Personalized Recipe

Select the option that best describes you in the last 3 days. You can only select one option for each question.

1. How is your appetite?

Not really hungry, can skip meals easily or snacking

Hungry- definitely need to eat

Happy to eat, but not voracious or not hungry in the morning

2. How does your temperature feel?

More cold and/or I would rather be hot than cold

More hot and/or I would rather be cold than hot

Haven't really noticed, feel fine

3. How is your sleep?

It was hard to go to sleep, mind active OR went to bed after 10pm

Went to sleep ok, but kept waking up or restless OR woke up early (before 6am)

Slept deeply, but harder to wake up in the morning OR waking up after 6am

4. How many times did you have a bowel movement daily?

Not today or incomplete or 1-2 times with smaller stools or hard stools

2 or more times and/or stool is softly formed or very soft or urgency or diarrhea

1-2 larger formed stools and/or sticky stool and/or slow to come out

5. What is the shape of your stool?

Small, thin or hard pieces or none

Medium, banana-like, loose, soft serve or runny

Large, long, banana or large sausage

6. How many wipes after your bowel movement?

Single or none at all

One to two wipes

Multiple wipes

7. What is the color of your stool?

Dark/grey, tan or no stool

Orange tint, red, light or green

Brown like earth or chocolate