O R G A N I C S

Client Chakra Consultation Questionnaire

greenenvee.com

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

NO SOMETIMES YES

1. I generally feel in harmony with the universe............................

2. My intuition is extremely developed..........................................

3. I express myself well in words..................................................

4. I feel emotionally connected with other people.........................

5. I follow my gut instincts............................................................

6. I am full of vitality and life.........................................................

7. I love to be in movement and feel my own body........................

8. It is easy for me to meditate and find inner peace.....................

9. I have good concentration.........................................................

10. I feel socially confident...........................................................

11. I do not fear being alone.........................................................

12. Eating is one of the great pleasures in life..............................

13. I know how to enjoy life..........................................................

14. I almost never worry...............................................................

15. I find it difficult to take the world seriously..............................

16. I often think about the world and life.......................................

17. I can easily put my thoughts into words..................................

18. Love is the most important thing in the world..........................

19. I am at peace with myself and not easily thrown off center.....

20. I am a very passionate person.................................................

21. I feel deeply connected with nature.........................................

22. My soul's home does not lie in this world................................

23. I have intense color-filled dreams............................................

24. I have many different interests...............................................

25. I have the desire to express myself artistically.........................

26. I experience feelings mostly in my body...................................

27. Sex is very important to me.....................................................

28. I have a lot of confidence in life and the future........................

Part 1.Instructions: Respond to these statements with an absolute YES, NO, or SOMETIMES. Don’t think about them too much. Your answers should be intuitive and spontaneous.

1

8 15

22

2

9 16

23

3

10 17

24

4

11 18

25

5

12 19

26

6

13 20

27

7

14 21

28

Heart Chakra

Root Chakra

Crown Chakra

Third Eye Chakra

Sacral Chakra

Throat Chakra

Solar Plexus Chakra

Part 2.Instructions: For each question on the left to which you answered: (YES), shade in the corresponding number field in the circles below.

(NO) circle the corresponding number field in the circles below.

(SOMETIMES). Leave these blank Part 3.Test Evaluation

Balanced & Unblocked

Dominating Chakra

Weak Chakra

Blocked Chakra

Balanced & Unblocked

Dominating Chakra

Weak Chakra

Blocked Chakra

Balanced & Unblocked

Dominating Chakra

Weak Chakra

Blocked Chakra

Balanced & Unblocked

Dominating Chakra

Weak Chakra

Blocked Chakra

Balanced & Unblocked

Dominating Chakra

Weak Chakra

Blocked Chakra

Balanced & Unblocked

Dominating Chakra

Weak Chakra

Blocked Chakra

Balanced & Unblocked

Dominating Chakra

Weak Chakra

Blocked Chakra

O R G A N I C S

Chakra Equally Developed and Unblocked

Dominant Chakra

Chakra Test Result Key

Weak Chakra

Extremely Weak Chakra

Blocked or Closed Chakra (1 or more circled numbers)

Extremely Blocked or Closed Chakra (2 or more circled numbers)

IndividualChakra Result

Balanced and Healthy (No need for current improvement)

Over Developed (Do not intentionally nourish at this time)

Under Developed (Needs nourishment)

Under Developed (Needs immediate nourishment)

Under Developed (Needs nourishment)

Under Developed (Needs immediate nourishment)