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Spiritual Layer Questionnaire
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FIRST CHAKRA
(Root Chakra)
Do you experience a deep sense of not belonging on this planet or feeling disconnected from the world around you?
Do you experience a deep sense of not belonging on this planet or feeling disconnected from the world around you?
Yes
No
Have you faced significant and persistent blood-related health issues throughout your life?
Have you faced significant and persistent blood-related health issues throughout your life?
Yes
No
Has there been a history of bone cancer within your family?
Has there been a history of bone cancer within your family?
Yes
No
Do you find yourself persistently convinced that something negative or unfortunate will happen within your family?
Do you find yourself persistently convinced that something negative or unfortunate will happen within your family?
Yes
No
SECOND CHAKRA
(Sacral Chakra)
Is it common within your family and close surroundings to experience difficulties in maintaining harmonious relationships with their partners?
Is it common within your family and close surroundings to experience difficulties in maintaining harmonious relationships with their partners?
Yes
No
Is there a history of sterility or infertility issues within your family?
Is there a history of sterility or infertility issues within your family?
Yes
No
Do you hold a belief that you are incapable of having a successful and fulfilling partnership?
Do you hold a belief that you are incapable of having a successful and fulfilling partnership?
Yes
No
Have you reached a point where you have given up on or lost interest in pursuing sexual relationships?
Have you reached a point where you have given up on or lost interest in pursuing sexual relationships?
Yes
No
THIRD CHAKRA
(Solar Plexus Chakra)
Do you strongly believe that you are inherently worthless or lacking in value?
Do you strongly believe that you are inherently worthless or lacking in value?
Yes
No
Have you come to accept the idea that you lack physical strength or feel physically weak?
Have you come to accept the idea that you lack physical strength or feel physically weak?
Yes
No
Do you experience a chronic disease affecting one of the organs in your stomach or digestive system?
Do you experience a chronic disease affecting one of the organs in your stomach or digestive system?
Yes
No
FOURTH CHAKRA
(Heart Chakra)
Have you or your family members experienced a history of heart attacks?
Have you or your family members experienced a history of heart attacks?
Yes
No
Is sadness a prevalent and recurring emotion among family members?
Is sadness a prevalent and recurring emotion among family members?
Yes
No
Has breast cancer been a frequent occurrence across generations within your family?
Has breast cancer been a frequent occurrence across generations within your family?
Yes
No
Have you ever had thoughts like, "I don't want to breathe anymore"?
Have you ever had thoughts like, "I don't want to breathe anymore"?
Yes
No
Do you feel a sense of disconnection or loss of self-identity, where you struggle to recognize who you have become?
Do you feel a sense of disconnection or loss of self-identity, where you struggle to recognize who you have become?
Yes
No
FIFTH CHAKRA
(Throat Chakra)
Have you observed instances in your family where some of your parents or caregivers lacked self-expression capacity?
Have you observed instances in your family where some of your parents or caregivers lacked self-expression capacity?
Yes
No
Is poor dental health a common issue within your family, particularly among parents or other family members?
Is poor dental health a common issue within your family, particularly among parents or other family members?
Yes
No
Have you experienced conflicts between what your heart tells you and what your mind suggests since you can remember?
Have you experienced conflicts between what your heart tells you and what your mind suggests since you can remember?
Yes
No
SIXTH CHAKRA
(Third Eye Chakra)
Do you find this life to be "unacceptable" or challenging to cope with?
Do you find this life to be "unacceptable" or challenging to cope with?
Yes
No
Has depression been a recurring issue across generations within your family?
Has depression been a recurring issue across generations within your family?
Yes
No
Is there a history of poor ear health (deafness) or eye health problems within your family?
Is there a history of poor ear health (deafness) or eye health problems within your family?
Yes
No
SEVENTH CHAKRA
(Crown Chakra)
Is there a lack of acceptance or welcome towards God or spirituality within your family?
Is there a lack of acceptance or welcome towards God or spirituality within your family?
Yes
No
Due to a strained or negative relationship, do you feel disconnected or distant from your father?
Due to a strained or negative relationship, do you feel disconnected or distant from your father?
Yes
No
Do you believe that you are influenced or affected by negative entities or energies?
Do you believe that you are influenced or affected by negative entities or energies?
Yes
No
Do you consider yourself to be superior or better than those around you?
Do you consider yourself to be superior or better than those around you?
Yes
No
Thank you!
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