Kundalini Process (Spiritual Emergence) Assessment

Name

Email Address

Phone

Birthdate

City / State

What specific questions do you want me to address? If you list specific problems please indicate how often you have them, and when they are most likely to occur.

Please begin by describing your initial experience of spiritual or kundalini awakening, including the dates and your age at the time. What were you doing at the time?

Was there anything unusual or challenging going on in your life at the time of awakening?

What is your age, education and occupation? Are you working or going to school now?

What is your support system? Do they understand what is happening to you? Do you have a close personal relationship?

Are you on any medications? Which ones?

Do you use drugs or alcohol? Which ones?

Have you already tried any specific kinds of medical help or alternative health options to deal with your problems? What were they? Did they help?

Have you ever had shaktipat or worked with a spiritual teacher? If so please describe your experiences either positive or negative both mentally and physically.

Do you have any history of emotional or physical illness?

Can you give me a brief description of how you feel about your childhood and any dramatic or traumatic childhood incidents? Is there any abuse in your history? Were there any unusual childhood psychic or spiritual experiences? Any relatives who have also had unusual experiences or abilities?

Have you ever had a near-death experience?

What is your spiritual belief system? Has it changed since your spiritual or kundalini awakening?

Have you ever had any body therapy or psychotherapy? what kind and for how long?

Have you done any energy practices i.e. yoga, Tai Chi, Chi Gong, martial arts? For how long and with what results?

Do you meditate? What kind of meditation, for how long at a time and since what age? What happens when you meditate?

Do you have any creative outlets or practices?

Any other unusual experiences or events in your life that might be relevant?

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