(AW&Y, PLLC)(For Website)Chakra Assessment

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✨ Welcome to Your Chakra Assessment Ashakti Wellness & Yoga PLLC Your chakras are the energy centers of your body — and when they're out of balance, you may feel it as emotional heaviness, physical tension, mental fog, or a sense of being disconnected from yourself and others. This assessment will help you: 🌿 Identify which chakras need the most support 💡 Understand how energy imbalances may be showing up in your life 🌸 Receive personalized guidance to support your healing journey ⏱️ Takes approximately 5–10 minutes to complete 🔒 Your information is private and will never be shared 💛 There are no right or wrong answers — only your truth
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What is your name?* This field is required.Please be sure to list your full middle name (not initial).
First Name
Middle Name
Last Name
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What is your email address?* This field is required.
example@example.com
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What is a cell phone phone number (that can receive text)?* This field is required.
Area Code
Phone Number
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What is your identified gender?* This field is required.
Male
Female
Non-Binary
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What is your ethnicity?* This field is required.
Hispanic/Latino
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White/Caucasian
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What is your age?* This field is required.
< under 18 years old
18 years old - 24 years old
25 years old - 34 years old
35 years old - 44 years old
45 years old - 54 years old
55 years old - 64 years old
65 years old < older
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Welcome to Your Chakra Assessment 🌿
This is a safe, judgment-free space. There are no right or wrong answers here — only your truth.
As you move through each question, take a moment to breathe and check in with yourself. You are the expert of your own experience.
For each statement, simply rate how often it feels true for you over the past 6 months — not who you aspire to be, but where you honestly are right now. Your answers will help us identify which energy centers may need the most love and support.
💛 This assessment is for educational and wellness purposes only and is not a medical or mental health diagnosis.
Take your time. You've got this. 🌸
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🔴 Root Chakra — Muladhara | Safety & StabilityThe Root Chakra is your foundation — your sense of safety, belonging, and feeling at home in your body and in the world.
Rarely/Never
Sometimes
Often
Almost Always
Always
I feel safe and secure in my daily life.
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I feel grounded and connected to my body.
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I have a stable sense of home, finances, or basic needs.
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I feel a sense of belonging — to a place, community, or family.
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I am able to manage stress without feeling overwhelmed or panicked.
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I feel safe and secure in my daily life.
I feel grounded and connected to my body.
I have a stable sense of home, finances, or basic needs.
I feel a sense of belonging — to a place, community, or family.
I am able to manage stress without feeling overwhelmed or panicked.
Rarely/Never
Row 0, Column 0
Sometimes
Row 0, Column 1
Often
Row 0, Column 2
Almost Always
Row 0, Column 3
Always
Row 0, Column 4
Rarely/Never
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Sometimes
Row 1, Column 1
Often
Row 1, Column 2
Almost Always
Row 1, Column 3
Always
Row 1, Column 4
Rarely/Never
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Sometimes
Row 2, Column 1
Often
Row 2, Column 2
Almost Always
Row 2, Column 3
Always
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Rarely/Never
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Often
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Almost Always
Row 3, Column 3
Always
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Rarely/Never
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Sometimes
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Often
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Almost Always
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Always
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Root Chakra
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🟠 Sacral Chakra — Svadhisthana | Creativity & EmotionThe Sacral Chakra governs your emotions, creativity, pleasure, and your relationship with desire and flow.
Rarely/Never
Sometimes
Often
Almost Always
Always
I allow myself to feel and express my emotions without judgment.
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I experience joy, pleasure, and creativity in my daily life.
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I have a healthy and comfortable relationship with my body and sexuality.
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I allow things to flow and change without excessive fear or resistance.
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I feel inspired and connected to my creative energy.
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I allow myself to feel and express my emotions without judgment.
I experience joy, pleasure, and creativity in my daily life.
I have a healthy and comfortable relationship with my body and sexuality.
I allow things to flow and change without excessive fear or resistance.
I feel inspired and connected to my creative energy.
Rarely/Never
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Sometimes
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Often
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Almost Always
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Always
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Rarely/Never
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Often
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Almost Always
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Always
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Rarely/Never
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Often
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Almost Always
Row 2, Column 3
Always
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Rarely/Never
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Row 3, Column 1
Often
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Almost Always
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Always
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Rarely/Never
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Almost Always
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Always
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Sacral Chakra
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🟡 Solar Plexus Chakra — Manipura | Power & ConfidenceThe Solar Plexus Chakra is your inner fire — your confidence, personal power, and sense of self-worth.
Rarely/Never
Sometimes
Often
Almost Always
Always
I trust myself to make decisions that are right for me.
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I feel confident in who I am and what I offer the world.
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I am able to set boundaries without guilt or fear.
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I take action toward my goals without excessive self-doubt.
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I feel a strong sense of personal power and self-worth.
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I trust myself to make decisions that are right for me.
I feel confident in who I am and what I offer the world.
I am able to set boundaries without guilt or fear.
I take action toward my goals without excessive self-doubt.
I feel a strong sense of personal power and self-worth.
Rarely/Never
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Sometimes
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Often
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Almost Always
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Rarely/Never
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Almost Always
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Solar Plexus
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💚 Heart Chakra — Anahata | Love & ConnectionThe Heart Chakra is the center of love, compassion, forgiveness, and your capacity to give and receive connection.
Rarely/Never
Sometimes
Often
Almost Always
Always
I give and receive love and care with ease.
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I practice self-compassion and treat myself with kindness.
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I am able to forgive myself and others — even when it's hard.
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I feel deeply connected to the people in my life.
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I open my heart to others without fear of being hurt or rejected.
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I give and receive love and care with ease.
I practice self-compassion and treat myself with kindness.
I am able to forgive myself and others — even when it's hard.
I feel deeply connected to the people in my life.
I open my heart to others without fear of being hurt or rejected.
Rarely/Never
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Sometimes
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Almost Always
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Heart Chakra
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💙 Throat Chakra — Vishuddha | Voice & TruthThe Throat Chakra governs your ability to speak your truth, express yourself authentically, and be truly heard.
Rarely/Never
Sometimes
Often
Almost Always
Always
I feel comfortable expressing my thoughts, needs, and feelings.
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I speak my truth even when it feels uncomfortable or vulnerable.
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I feel heard and understood in my relationships.
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I communicate clearly and authentically in all areas of my life.
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I honor my voice and trust that what I have to say matters.
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I feel comfortable expressing my thoughts, needs, and feelings.
I speak my truth even when it feels uncomfortable or vulnerable.
I feel heard and understood in my relationships.
I communicate clearly and authentically in all areas of my life.
I honor my voice and trust that what I have to say matters.
Rarely/Never
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Throat Chakra
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👁️ Third Eye Chakra — Ajna | Intuition & ClarityThe Third Eye Chakra is your inner wisdom center — intuition, clarity, vision, and the ability to see beyond the surface.
Rarely/Never
Sometimes
Often
Almost Always
Always
I trust my intuition and inner guidance.
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I have a clear sense of direction and purpose in my life.
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I am able to quiet mental chatter and tune into my inner knowing.
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I see patterns in my life clearly and learn from them.
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I feel connected to something greater than my everyday thoughts.
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I trust my intuition and inner guidance.
I have a clear sense of direction and purpose in my life.
I am able to quiet mental chatter and tune into my inner knowing.
I see patterns in my life clearly and learn from them.
I feel connected to something greater than my everyday thoughts.
Rarely/Never
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Sometimes
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Often
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Almost Always
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Always
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Third Eye Chakra
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🔮 Crown Chakra — Sahasrara | Spirituality & ConnectionThe Crown Chakra connects you to universal wisdom, divine energy, and your deepest sense of meaning and purpose.
Rarely/Never
Sometimes
Often
Almost Always
Always
I feel connected to a higher power, the universe, or something beyond myself.
Row 0, Column 0
Row 0, Column 1
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I experience a sense of peace, meaning, and spiritual fulfillment.
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I trust that life is unfolding as it should, even in difficult times.
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I feel a sense of oneness — with myself, others, and the world.
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I am open to growth, healing, and spiritual expansion.
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I feel connected to a higher power, the universe, or something beyond myself.
I experience a sense of peace, meaning, and spiritual fulfillment.
I trust that life is unfolding as it should, even in difficult times.
I feel a sense of oneness — with myself, others, and the world.
I am open to growth, healing, and spiritual expansion.
Rarely/Never
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Crown Chakra
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✨ Thank you for completing your Chakra Assessment! Your total score range is 35–175. 🔴 35–75: Significant imbalances — deep healing support recommended 🟠 76–115: Moderate imbalances — targeted healing work will be very beneficial 🟡 116–150: Mild imbalances — refinement practices recommended 💚 151–175: Well balanced — continue your beautiful healing journey 🌸 Your personalised results will be sent to your email within 24 hours by Ashakti Wellness & Yoga PLLC.
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