CHAKRA HISTORY FORM
Name: *
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Email Address: *
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CHAKRA HISTORY
Please list emotional or physical traumas, surgeries, medical issues, and any major events that occurred to you or your loved ones at the appropriate ages below. Every 30 years we begin a new cycle so fill out the form about those things that happened after age 30. Then do the same for after age 60 if needed.
ROOT CHAKRA- ages birth-4-5: *
Your answer
SACRAL CHAKRA- ages 5-8: *
Your answer
SOLAR PLEXUS CHAKRA- ages 8-12: *
Your answer
HEART CHAKRA- ages 12-16: *
Your answer
THROAT CHAKRA- ages 16-21: *
Your answer
BROW CHAKRA- ages 21-26: *
Your answer
CROWN CHAKRA- ages 26-30: *
Your answer
After Age 30
ROOT CHAKRA- ages 30-35:
Your answer
SACRAL CHAKRA- ages 35-38:
Your answer
SOLAR PLEXUS CHAKRA- ages 38-42:
Your answer
HEART CHAKRA- ages 42-46:
Your answer
THROAT CHAKRA- ages 46-51:
Your answer
BROW CHAKRA- ages 41-56:
Your answer
CROWN CHAKRA- ages 46-60:
Your answer
After Age 60
ROOT CHAKRA- ages 60-65:
Your answer
SACRAL CHAKRA- ages 65-68:
Your answer
SOLAR PLEXUS CHAKRA- ages 68-72:
Your answer
HEART CHAKRA- ages 72-76:
Your answer
THROAT CHAKRA- ages 76-81:
Your answer
BROW CHAKRA- ages 81-86:
Your answer
CROWN CHAKRA- ages 86-90:
Your answer
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