not been able to recover from. 1 2 3 4 510 (Women only) I have health issues with my reproductive organs (for example, uterus, ovaries). 1 2 3 4 5
11 I prefer being alone rather than being with others, or I cannot tolerate being alone. 1 2 3 4 5
12 I see myself as either an overly creative or noncreative person. 1 2 3 4 5
13 I have challenges around expressing my sexuality, or I express my sexuality too freely. 1 2 3 4 5
14 Conveying my emotions to others is difficult. 1 2 3 4 5
15 Commitment to a project or a relationship can be a challenge for me. 1 2 3 4 5
Sacral Chakra Total: ________
Section 3: Solar Plexus Chakra
1 = Does Not Apply 3 = Applies Sometimes 5 = Applies All the Time
1 Achievement of a goal is very important to me. 1 2 3 4 5
2 I exhaust myself by thinking too much. 1 2 3 4 5
3 I would call myself overstressed. 1 2 3 4 5
4 Saying “No” to people is difficult for me. 1 2 3 4 5
5 I don't do well when presented with many choices. 1 2 3 4 5
6 I crave high-energy foods to keep me going. 1 2 3 4 5
7 I would say that I am addicted to sugar. 1 2 3 4 5
8 I suffer from digestive complaints, mainly indigestion and bloating. 1 2 3 4 5
9 I need external substances (food, drugs, alcohol) to help me relax. 1 2 3 4 5
10 My weight fluctuates often. 1 2 3 4 5
11 I tend to be a perfectionist. 1 2 3 4 5
12 After I have been around other people, I feel drained of energy. 1 2 3 4 5
13 I lack self-confidence, or I have an inflated sense of confidence. 1 2 3 4 5
14 I find myself worrying about what others will think of me. 1 2 3 4 5
15 Most people would call me analytical, and maybe even critical. 1 2 3 4 5
Solar Plexus Chakra Total : _________
Section 4: Heart Chakra
1 = Does Not Apply 3 = Applies Sometimes 5 = Applies All the Time
1 My moods change often and I tend to be melodramatic. 1 2 3 4 5
2 I rarely have a chance to do what is best for me, or I tend to be overly selfish. 1 2 3 4 5
3 I neglect to eat green vegetables. 1 2 3 4 5
4 My hands get cold easily. 1 2 3 4 5
5 I am anxious. 1 2 3 4 5
6 Only select people are allowed to be close to me, physically or emotionally. 1 2 3 4 5
7 I have not felt true joy or happiness in recent years. 1 2 3 4 5
8 I feel shut down from my deepest feelings. 1 2 3 4 5
9 For the most part, my decisions are purely intellectual. 1 2 3 4 5
10 I have some form of heart disease (for example, atherosclerosis, arteriosclerosis, heart failure, heart attack, high cholesterol). 1 2 3 4 5
11 If I let myself cry, I feel that I may not be able to stop. 1 2 3 4 5
12 I lack passion for anything in life. 1 2 3 4 5
13 I find it difficult to touch or to be touched. 1 2 3 4 5
14 A traumatic event in my life has caused me to be unable to connect with my emotions. 1 2 3 4 5
15 I have issues receiving or giving love. 1 2 3 4 5
Heart Chakra Total: ________
Section 5: Throat Chakra
1 = Does Not Apply 3 = Applies Sometimes 5 = Applies All the Time
1 My verbal expression has been limited or excessive. 1 2 3 4 5
2 It is not my nature to speak up when I have been wrongfully accused. 1 2 3 4 5
3 I have chewing or swallowing difficulties. 1 2 3 4 5
4 Speaking my personal truth has not come easy. 1 2 3 4 5
5 My voice becomes raspy and my throat dry when I try to speak something I feel strongly about. 1 2 3 4 5
6 My metabolism is too slow or too fast. 1 2 3 4 5
7 Either I talk too much or I am afraid to speak for fear of being punished. 1 2 3 4 5
8 I have thyroid problems. 1 2 3 4 5
9 I've dealt with eating disorders (for example, anorexia, bulimia). 1 2 3 4 5
10 It is easier for me to write my feelings than to speak them. 1 2 3 4 5
11 My hearing and sense of smell are either deadened or heightened. 1 2 3 4 5
12 Surrendering to a Higher Power is a difficult concept for me. 1 2 3 4 5
13 Praying is not something I feel comfortable doing. 1 2 3 4 5
14 I tend to agree with others rather than create any discord. 1 2 3 4 5
15 My opinion is less or more important than the harmony of a group. 1 2 3 4 5
Throat Chakra Total: _______
Section 6: Third Eye Chakra
1 = Does Not Apply 3 = Applies Sometimes 5 = Applies All the Time
1 My life purpose is unclear. 1 2 3 4 5
2 I am prone to depression. 1 2 3 4 5
3 My dreams can either be nightmarish and vivid or I can rarely remember them. 1 2 3 4 5
4 My mind often goes blank or is cluttered with random thoughts. 1 2 3 4 5
5 I feel out of touch with my intuition. 1 2 3 4 5
6 My needs for sleep seem to be very different from what most people need. 1 2 3 4 5
7 I cannot go without caffeine. 1 2 3 4 5
8 I tend to live inside my own mind and find myself daydreaming often. 1 2 3 4 5
9 My eyesight is diminished. 1 2 3 4 5
10 Drugs are a part of my life or were a part of
