Chakra essentially means ‘wheel’. When our energy chakras or ‘wheels’ are in balance, they spin like a vortex. When someone is under physical or mental stress, the energy chakras become stagnant or blocked, but they may also speed up or slow down, becoming imbalanced and can affect the body-mind-spirit.

This questionnaire is to determine which areas to focus on for balancing your energy chakras. It is important to be honest and thorough when filling it out in order to properly determine imbalances in chakras. The questionnaire is for your own personal use.

Provided are short description of each chakra and its associations and possible imbalances to better understand them better.

Root (1st) Chakra- Located at Base of Spine/Perineum
Color: Red
Characteristics: Survival, Security, Grounding, Home, Health and Vitality
Physical Associations: Constipation, Obesity, Arthritis, Feet & Legs, Low Stamina, Spine, Adrenal Glands, Kidneys
Signs of Imbalance: Fear, Insecurity, Instability, Possessiveness, Disconnected from Body, Weight Issues, Materialistic

Sacral (2nd) Chakra- Located at Lower Abdomen/Pelvic Region
Color: Orange
Characteristics: Sex and Reproduction, Desire and Pleasure, Creativity, Personal Relationships
Physical Associations: Urinary and Reproductive systems, Lower Back, Fluids in Body
Signs of Imbalance: Sexual Problems, Lack of Enthusiasm, Addictions, Mood Swings

Solar Plexus (3rd) Chakra- Located at Mid Abdomen
Color: Yellow
Characteristics: Identity & Individuality, Personal Power, Self-Worth, Will Power, Social Relationships
Physical Associations: Digestive System and Sugar Balance, Metabolism and Heat Regulation, Mid-Back
Signs of Imbalance: Weak-Willed, Stubborn, Unreliable, Manipulative, Addicted to Approval, Lacking Self-Confidence, Struggle, Inability to Express Anger, Hyperactive, Judgmental of Self and Others

Heart (4th) Chakra- Located at Chest
Color: Green
Characteristics: Love, Compassion, Concern For Others, Intimacy, Nurturing, Artistic Enjoyment
Physical Associations: Circulatory system and Lungs, Breasts, Upper Back, Hands & Arms, Touch, Thymus Gland, Immune System
Signs of Imbalance: Attachment, Greed, Jealousy, Depression, Auto-Immune Issues, Anti-Social Feelings, Fear of Intimacy, Overly Sensitive

Throat (5th) Chakra- Located at Throat
Color: Blue
Characteristics: Expression, Communication, Creativity, Honesty, Organization of Time, Rational Thought
Physical Associations: Bronchi, Vocal Chords, Mouth, Thyroid and Parathyroid Glands
Signs of Imbalance: Shyness, Fear of Public Speaking, Talking Too Much or Too Little, Dishonesty, Vertigo, Rushed

Third Eye (6th) Chakra- Located at Forehead Between Eyes
Color: Indigo
Characteristics: Intellectual and Intuitive Understanding, The Subconscious, Dreams, Memory, Imagination, Idealism
Physical Associations: Brain, Eyes, Ears, Sense of Smell, Nervous System, Pituitary Gland
Signs of Imbalance: Headaches/Migraines, Forgetfulness, Nightmares, Sleeplessness, Heady, Difficulty Concentrating, Out of Touch With Reality

Crown (7th) Chakra- Located at top of Head 
Color: Violet
Characteristics: Connection with The Divine, Higher Consciousness, Self-Knowledge, Spirituality
Physical Associations: Pineal Gland, Brain, Central Nervous System
Signs of Imbalance: Lack of Purpose In Life, Fear of Death, Coma, Epilepsy

* Please read: Please mark all that apply for each question. Take your time and be as honest as possible. When you are done, add up all selected for each corresponding # and place into provided total lines. 

1. Which area(s) of your body concern you?

1___ Feet & Legs 
2___ Between Waist & Hips 
3___ Waist 
4___ Chest 
5___ Neck & Shoulders 
6___ Face 
7___ Head

2. Which area(s) of your body do you dislike?

1___ Feet & Legs 
2___ Between Waist & Hips 
3___ Waist 
4___ Chest 
5___ Neck & Shoulders 
6___ Face 
7___ Head

3. Which area(s) of your body are you proud of?

1___ Feet & Legs 
2___ Between Waist & Hips 
3___ Waist 
4___ Chest 
5___ Neck & Shoulders 
6___ Face 
7___ Head

4. Which area(s) of your body are affected by major health issues?

1___ Feet & Legs 
2___ Between Waist & Hips 
3___ Waist 
4___ Chest 
5___ Neck & Shoulders 
6___ Face 
7___ Head

5. Which area(s) of your body are affected by minor health issues?

1___ Feet & Legs 
2___ Between Waist & Hips 
3___ Waist 
4___ Chest 
5___ Neck & Shoulders 
6___ Face 
7___ Head

6. Which colour(s) do you like the most?

1___ Red 
2___ Orange 
3___ Yellow 
4___ Green 
5___ Blue 
6___ Dark Blue 
7___ Violet

7. Which colour(s) do you like the least? 

1___ Red 
2___ Orange 
3___ Yellow 
4___ Green 
5___ Blue 
6___ Dark Blue 
7___ Violet

8. Which are your favourite food(s)?

1___ Meat/Fish/Proteins 
2___ Rice/Orange Fruits 
3___ Wheat/Yellow Fruits 
4___ Green Fruit & Vegetables

9. Which type of exercises/activities interest you the most?

1___ Fast Action 
2___ Dancing/Painting 
3___ Crosswords/Puzzles 
4___ Anything Outdoors 
5___ Drama/Singing 
6___ Mystery/Crime Novels 
7___ Doing Nothing

10. What sort of people do you look up to/admire?

1___ Sports Athletes 
2___ Artists/Musicians 
3___ Intellectuals 
4___ Conversationalists 
5___ Speakers/Politicians 
6___ Inventors 
7___ Mystics/Religious Figures

11. What sort of person do you think yourself as?

1___ Get on with things
2___ Creative 
3___ Thinker/Worker 
4___ Emotional 
5___ Chatterbox 
6___ Quiet 
7___ Daydreamer

12. What emotional characteristics do you consider are most frequent in your life?

1___ Passionate 
2___ Easy-going 
3___ Contented 
4___ Caring, Sharing 
5___ Loyal 
6___ Helpfully Distant 
7___ Sympathetic

13. What emotions do you have that you would like to change?

1___ Temper 
2__ Possessiveness 
3___ Confusion 
4___ Insecurity 
5___ Needing things to be ‘black & white’ 
6___ Feeling separate from others 
7___ Not saying ‘No’

14. If you get angry, what is your most common reaction?

1___ Rage/Tantrums 
2___ Sullen Resentment 
3___ Get Frightened 
4___ Blame Yourself 
5___ Keep Quiet 
6___ Withdraw 
7___ Pretend Nothing Happened

15. What are you most afraid of?

1___ Dying 
2___ Lack of Sensation 
3___ Things you don’t understand 
4___ Being Alone 
5___ Having no one to talk to 
6___ Losing your way 
7___ Difficult Decisions

16. Which of these describes the way you tend to learn?

1___ Fast 
2___ Slowly 
3___ Quick but forget 
4___ Through feelings/hands-on
5___ Repetitiveness 
6___Instinctively 
7___ Can’t be bothered

17. What best describes your reaction to situations?

1___ Enthusiastic 
2___ Go with the flow 
3___ Think things through 
4___ See how things feel 
5___ Ask a lot of questions 
6___ See the patterns then act 
7___ Drift along without care

18. If you are criticized or reprimanded, what is your usual response? 

1___ Anger
2___ Resentment 
3___ Fear 
4___ Self-Blame 
5___ Verbal Riposte 
6___ Think about it 
7___ Denial

19. How would you describe your favourite books/films/video games?

1___ Combat/Action 
2___ Art 
3___ Skill, Intellectual 
4___ Romances 
5___ Dramas 
6___ Detective Stories/Suspense 
7___ Spiritual/Self-Development 

TOTALS 
Count up the total of each #:  

1's _____                 

2's _____           

3's _____  

4's _____                 

5's _____  

6's _____

7's _____

Guided Cds on Chakra Meditation is available in Sacred Space.