Chakra Assessment

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

Root Chakra

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

Sacral Chakra

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

Solar Plexus

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

Heart Chakra

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

Throat Chakra

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

Third Eye Chakra

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

Crown Chakra

Chakra Discovery Assessment Form