Adiwana Bisma Ubud
Arrival Date
Email
Name
Treatment
Telephone/Whatsapp
Therapist
Which best describes your skin?
- Tends to be dry and always needs to be moisturized
- My skin is fairly thick (may be prone to acne)
- Tends to be sensitive, warm, reddish, inflamed, and/or oily
Which best describes your build?
- I am small-boned with a thin build and prominent joints
- I am of medium build and have a fairly well-balanced body
- I have a solid, ample or stocky build with larger bone structure.
Which best describes your appetite
I have a hearty appetite and digest food quickly. I can get irritable if I miss a meal or can’t eat when I'm hungry
My appetite is irregular, sometimes I'm hungry and other times I'm not
I tend to feel heavy after eating and have a sluggish digestion.
Which best describes your memory?
- I'm good at picking up new things but my long-term memory is poor
- Good
- Slow but once I remember something it tends to stick
Which best describes how you react to stress?
- It makes me angry, frustrated, and/or irritable
- It makes me anxious, fearful, and/or insecure
- I'm fairly calm under stress. However, I tend to
avoid difficult situations
Which best describes your sleep?
- I'm a light sleeper
- I sleep well
- I'm a heavy, sound sleeper
Which best describes your bowel movements?
- Irregular, hard, dry
- Easy, regular, soft, loose
- Thick, heavy, slow
Which best describes you?
- I don't like the cold. I prefer warm food and drinks
- I don't like heat. It makes me tired and I perspire easily
- I don't like humid or damp environments
Which best describes you?
- It's relatively hard for me to put on weight
- I put on weight like most people
- I gain weight easily and find it hard to lose
Which best describes your build?
- Creative, enthusiastic, active, and somewhat restless
- Determined, impatient, critical, stubborn, and easy to anger
- Even-tempered, patient, compassionate, and not particularly
high-energy
Which best describes the kind of illnesses you are susceptible to?
- Congestion, water retention, cystic acne, and/or lethargy
- Inflammation, hypertension, hypersensitivity (allergies, rashes, arthritis, etc) and/or aggression
- Constipation, anxiety, nervousness, and/or insomnia
Do you suffer any allergy to any of the following?
Ginger
Milk
Lime
Cucumber
Avocado
Other
Any area of your body that we should concentrate on?
Head
Hand
Face
Feet
Shoulder
Thigh
Neck
Lower back
Leg
Other
How did you heard about Tejas Spa
Web
Magazine
Instagram
Facebook
Tripadvisor
I fully undertand that this consultation is only intended for treatment purposes at Tejas Spa, and not for medical purposses.
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