Chakra Assessment

Chakra Discovery Assessment Form

The purpose of this assessment is to gauge imbalances that may be present in your Chakra system. However, our energies vary based on different circumstances and situations presented in our daily lives.
Name

First Name Last Name
Email
example@example.com
Please rate the overall frequency/agreement with the statements below. Answer as openly and honestly as possible. Please base your responses on your behaviors, moods, and feelings over the course of the past 6 months.

Root Chakra

	Never / Strongly Disagree	Not Often / Disagree	Sometimes / Maybe	Often / Agree	Always / Strongly Agree
1) I often spend time in nature
2) I exercise regularly
3) The world feels safe to me
4) I eat a balanced, healthy diet
5) I am a grounded person
6) I have confidence in myself
7) I do not worry about what others think of me
8) I do not need material possessions to make me happy
9) I am a patient person
10) I face my problems without running away from them

Sacral Chakra

	Never / Strongly Disagree	Not Often / Disagree	Sometimes / Maybe	Often / Agree	Always / Strongly Agree
1) I let go of things easily
2) I am very affectionate, touching people freely
3) I am satisfied with my love life
4) I enjoy nurturing other people
5) I regularly "escape" with hobbies and enjoyable activities
6) I am comfortable with my gender
7) I am in control of my emotions
8) I am content spending time by myself
9) I am compassionate towards others
10) I feel comfortable about my body

Solar Plexus

	Never / Strongly Disagree	Not Often / Disagree	Sometimes / Maybe	Often / Agree	Always / Strongly Agree
1) I have a strong sense of personal power
2) I have a high energy level
3) I have a strong metabolism
4) I set and achieve goals
5) I am confident
6) I do not let other people make me feel like a victim
7) I have good self-esteem
8) I accept responsibility for my actions
9) I am comfortable taking risks
10) I am not critical of others, giving praise freely

Heart Chakra

	Never / Strongly Disagree	Not Often / Disagree	Sometimes / Maybe	Often / Agree	Always / Strongly Agree
1) I'm generally a happy person
2) I make friends easily
3) I like myself
4) I have successful long-term relationships
5) I am at peace with my current situation
6) I forgive others easily
7) I am not a jealous or possessive person
8) I feel inspired in my life
9) I am compassionate towards others
10) I believe that I have the power to heal myself

Throat Chakra

	Never / Strongly Disagree	Not Often / Disagree	Sometimes / Maybe	Often / Agree	Always / Strongly Agree
1) I am an effective communicator
2) I enjoy expressing myself through writing, art, or music
3) I am a good listener
4) I am a creative person
5) I get along well with other people
6) I feel heard by my family and friends
7) I have good hearing
8) I can express myself easily through words
9) I am comfortable with my voice
10) I am an honest person

Third Eye Chakra

	Never / Strongly Disagree	Not Often / Disagree	Sometimes / Maybe	Often / Agree	Always / Strongly Agree
1) I am very aware of my physical surroundings, noticing visual details
2) I have vivid dreams
3) I often experience deja vu or coincidence
4) I have a strong ability to visualize or "picture" things
5) I am imaginative
6) I trust my intuition
7) I have a good memory
8) I experience psychic connections with other people
9) I experience clairvoyance or telepathy
10) I have good eye sight

Crown Chakra

	Never / Strongly Disagree	Not Often / Disagree	Sometimes / Maybe	Often / Agree	Always / Strongly Agree
1) I meditate/pray/contemplate
2) I am self-aware, reflective and conscious of my thoughts, actions, motives
3) I nurture my spirituality
4) I consider myself an intellectual person
5) I am aware of the interconnectedness of all things
6) I can think for myself
7) I am aware when I have become overly attached to an idea or an object
8) I have self-reliance in spiritual matters
9) I love to learn
10) I enjoy taking tests like these

Chakra Discovery Assessment Form