Your Chakra Assessment - How Balanced Are You?

Name:
Date of Birth
Email:
I am experiencing physical issues with my spine, kidneys and/or bladder.
Never
Sometimes/Not often
Always/Most of the time
Do you feel that you are exhibiting any aggression?
Never
Sometimes/Not often
Always/Most of the time
Do you feel that your basic needs are met?
Never
Sometimes/Not often
Always/Most of the time
Do you feel as if you are lacking confidence?
Never
Sometimes/Not often
Always/Most of the time
Do you feel as if you are lacking sexual interest?
Never
Sometimes/Not often
Always/Most of the time
I feel anxious, fearful, and/or unsafe.
Never
Sometimes/Not often
Always/Most of the time
Do you feel disconnected from yourself?
Never
Sometimes/Not often
Always/Most of the time
Are you experiencing any physical issues with your bladder, kidney, or circulation?
Never
Sometimes/Not often
Always/Most of the time
Do you suffer from headaches or migraines?
Never
Sometimes/Not often
Always/Most of the time
Do you feel that you are exhibiting any manipulative or overindulgent tendencies?
Never
Sometimes/Not often
Always/Most of the time
Do you find yourself feeling resentful and/or guilty?
Never
Sometimes/Not often
Always/Most of the time
Do you feel mistrustful of yourself, your inner voice or others?
Never
Sometimes/Not often
Always/Most of the time
Do you feel isolated or disconnected from others?
Never
Sometimes/Not often
Always/Most of the time
Do you feel that you are experiencing a peaceful life?
Never
Sometimes/Not often
Always/Most of the time
I feel / I am creative.
Never
Sometimes/Not often
Always/Most of the time
Are you experiencing physical issues with your digestion?
Never
Sometimes/Not often
Always/Most of the time
Do you have a preoccupation with your self-image or social status?
Never
Sometimes/Not often
Always/Most of the time
Do you find that you are overworking?
Never
Sometimes/Not often
Always/Most of the time
I feel depressed, insecure and/or fearful.
Never
Sometimes/Not often
Always/Most of the time
Does it make you anxious or fearful about being alone?
Never
Sometimes/Not often
Always/Most of the time
Do you make decisions with confidence and conviction?
Never
Sometimes/Not often
Always/Most of the time
Do you feel that you are your most authentic self?
Never
Sometimes/Not often
Always/Most of the time
Do you have any physical issues with your heart?
Never
Sometimes/Not often
Always/Most of the time
Do you have a fear of rejection or require constant reassurance?
Never
Sometimes/Not often
Always/Most of the time
Do you find it difficult to have genuine compassion, love and empathy for yourself or others?
Never
Sometimes/Not often
Always/Most of the time
Do you feel withdrawn, closed off or have challenges relating to others?
Never
Sometimes/Not often
Always/Most of the time
Do you find yourself being overly critical, possessive or moody?
Never
Sometimes/Not often
Always/Most of the time
Do you find yourself being overly giving to others?
Never
Sometimes/Not often
Always/Most of the time
Do you tend to give to others more than to yourself?
Never
Sometimes/Not often
Always/Most of the time
Do you feel you are worthy of receiving love?
Never
Sometimes/Not often
Always/Most of the time
Do you feel that your past is a barrier to living your best life now?
Never
Sometimes/Not often
Always/Most of the time
Do you have any physical issues with your thyroid gland, hormones, throat, jaw, neck, mouth or any functions of the head?
Never
Sometimes/Not often
Always/Most of the time
Do you often feel over-stimulated?
Never
Sometimes/Not often
Always/Most of the time
Do you find yourself displaying arrogance or dominating conversations?
Never
Sometimes/Not often
Always/Most of the time
Do you easily share your opinions and desires with others?
Never
Sometimes/Not often
Always/Most of the time
Do you find yourself being unreliable or manipulative?
Never
Sometimes/Not often
Always/Most of the time
Do you struggle with communication, creativity or self-expression?
Never
Sometimes/Not often
Always/Most of the time
Do you find it easy to share your wisdom, truth and experiences with others?
Never
Sometimes/Not often
Always/Most of the time
Do you experience issues with your eyes, ears, nose, nervous system and/or sinuses?
Never
Sometimes/Not often
Always/Most of the time
Do you have difficulty concentrating or get lost in fantasy?
Never
Sometimes/Not often
Always/Most of the time
Do you feel that you are disconnected from reality?
Never
Sometimes/Not often
Always/Most of the time
Do you find your memory to be dull?
Never
Sometimes/Not often
Always/Most of the time
Are you indecisive?
Never
Sometimes/Not often
Always/Most of the time
I feel like I deserve a good life.
Never
Sometimes/Not often
Always/Most of the time
Do you feel disconnected from a higher source/power?
Never
Sometimes/Not often
Always/Most of the time
I find myself frustrated.
Never
Sometimes/Not often
Always/Most of the time
Are you restless?
Never
Sometimes/Not often
Always/Most of the time
Do you find happiness and joy in life?
Never
Sometimes/Not often
Always/Most of the time
I trust myself.
Never
Sometimes/Not often
Always/Most of the time
I see goodness in everyone.
Never
Sometimes/Not often
Always/Most of the time
It is easy for me to go beyond my limiting beliefs.
Never
Sometimes/Not often
Always/Most of the time
I accept myself as a I am.
Never
Sometimes/Not often
Always/Most of the time
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