Heart Chakra Self Assessment
Please fill out your personal information and answer the assessment questions below for your coaching session. Notice: we do not share or sell personal information with third parties.
Sign in to Google to save your progress. Learn more
Date : *
MM
/
DD
/
YYYY
Name : *
Phone : *
Email :
1. I love myself and others unconditionally. *
2. I give and receive love effortlessly. *
3. I am fearful of opening my heart to others. *
4. I freely give my gifts to the world. *
5. I am in alignment with my Higher Self. *
6. I strengthen the function of my heart and lungs through deep breathing. *
7. I graciously receive gifts from others. *
8. My heart is open to receive the energy of love. *
9. I easily feel gratitude. *
10. I reach out for love and support when I am challenged. *
11. I identify and release “world pain” and despair without attaching to it. *
12. Grief closes down our Heart Chakra which affects our Right To Love And Be Loved. What are you grieving about? *
Select Coach and Email *
1. For Cinda: select cinda@primemychakras. com 2. For Rochel: select infinitelivingnow@gmail. com      3. For Greg: select gmoreyone@yahoo. com
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms