Unleash Your Inner Wild!

Orgasmic Energy Flow AssessmentTM Instructions: For each issue or symptom listed that you have experienced in the last 6 months, check “Yes.” If you checked “Yes” for an item, rank the intensity of your experience with that problem or physical symptoms on a scale of 1-5 with 1 being mild and 5 being extreme. Add your total for each section, and put it in the space indicated. Regarding the associated “color frequency” for each section, you’ll learn more about that and what color to fill in during Video #2 of the “Unleash Your Inner Wild!” video series at www.UnleashYourInnerWild.com NOTE: This is assessment is not intended to diagnose, treat or cure any mental, emotional or physical symptom or disease.

© 2016 Extatica, Inc.

Orgasmic Energy Flow AssessmentTM www.extatica.com/InnerWild/

Page 1 of 7

A. Experienced issues or symptoms in this realm in last 6 months? 1.

Shock:

2.

Numbness:

If YES, rank INTENSITY from 1 (mild) to 5 (extreme)

No ___ Yes ___:

___

(emotional or physical)

No ___ Yes ___:

___

3.

Dissociated

No ___ Yes ___:

___

4.

Death wish:

No ___ Yes ___:

___

5.

Separation anxiety

No ___ Yes ___:

___

6.

Hyper sensory/aroused

No ___ Yes ___:

___

7.

Survival insecurity:

No ___ Yes ___:

___

8.

Hips, buttocks:

No ___ Yes ___:

___

9.

Rectum, anus:

No ___ Yes ___:

___

10. Bones:

No ___ Yes ___:

___

11. Lower legs, feet, ankles:

No ___ Yes ___:

___

12. Coccyx/tail bone, sacrum

No ___ Yes ___:

___

No ___ Yes ___:

___

13. 5

th

Lumbar

Section A:

Color Frequency: _____________

Total: ____

B. 1.

Aimless, bored:

No ___ Yes ___:

___

2.

Little or no sexual activity:

No ___ Yes ___:

___

3.

Aberrant sexuality:

No ___ Yes ___:

___

4.

Problems with rage or anger:

No ___ Yes ___:

___

5.

Fear of danger:

No ___ Yes ___:

___

6.

Prostate:

No ___ Yes ___:

___

7.

Lower back muscles:

No ___ Yes ___:

___

8.

Sciatic:

No ___ Yes ___:

___

9.

Sex organs:

No ___ Yes ___:

___

10. Uterus:

No ___ Yes ___:

___

11. Bladder:

No ___ Yes ___:

___

No ___ Yes ___:

___

No ___ Yes ___:

___

12. Knees 13. 4

th

and/or 3

Section B:

rd

Lumbar

Color Frequency: _____________

© 2016 Extatica, Inc.

Total: ____

Orgasmic Energy Flow AssessmentTM www.extatica.com/InnerWild/

Page 2 of 7

C. Experienced problems or symptoms in this realm in last 6 months?

If YES, rank INTENSITY from 1 (mild) to 5 (extreme)

1.

Guilt:

No ___ Yes ___:

___

2.

Shame:

No ___ Yes ___:

___

3.

Inhibition, rigidity:

No ___ Yes ___:

___

4.

Excessive sense of responsibility, sacrificial:

No ___ Yes ___:

___

5.

Critical:

No ___ Yes ___:

___

6.

Hypervigilant

No ___ Yes ___:

___

7.

Appendix:

No ___ Yes ___:

___

8.

Abdomen:

No ___ Yes ___:

___

9.

Large intestines/colon:

No ___ Yes ___:

___

10. Uterus:

No ___ Yes ___:

___

11. Bladder:

No ___ Yes ___:

___

No ___ Yes ___:

___

No ___ Yes ___:

___

12. Upper leg, knees: 13. 2

nd

st

and/or 1 Lumbar

Section C:

Color Frequency: _____________

Total: ____

D. 1.

Inept, excessive passivity:

No ___ Yes ___:

___

2.

Feels worthless:

No ___ Yes ___:

___

3.

Ego distortion (arrogant or lack of identity):

No ___ Yes ___:

___

4.

Lack of personal boundaries:

No ___ Yes ___:

___

5.

Self-absorbed:

No ___ Yes ___:

___

6.

Inferiority (lack of confidence): No ___ Yes ___:

___

7.

Rebellious

No ___ Yes ___:

___

8.

Self-hatred

No ___ Yes ___:

___

9.

Small intestines:

No ___ Yes ___:

___

10. Lymph circulation:

No ___ Yes ___:

___

11. Kidneys:

No ___ Yes ___:

___

No ___ Yes ___:

___

No ___ Yes ___:

___

12. Penis, urethra th

th

13. 12 , 11 , 10 Section D:

th

thoracic:

Color Frequency: _____________

© 2016 Extatica, Inc.

Total: ____

Orgasmic Energy Flow AssessmentTM www.extatica.com/InnerWild/

Page 3 of 7

E. Experienced problems or symptoms in this realm in last 6 months? 1.

If YES, rank INTENSITY from 1 (mild) to 5 (extreme)

Excessive sense of power/ excessive need to control:

No ___ Yes ___:

___

2.

Helplessness, panic:

No ___ Yes ___:

___

3.

Resentment, frustration:

No ___ Yes ___:

___

4.

Aggressive, desire to fight:

No ___ Yes ___:

___

5.

Anger, rage:

No ___ Yes ___:

___

6.

Victimized/trapped:

No ___ Yes ___:

___

7.

Adrenal, supra-adrenal glands: No ___ Yes ___:

___

8.

Solar Plexus:

No ___ Yes ___:

___

9.

Spleen:

No ___ Yes ___:

___

10. Pancreas:

No ___ Yes ___:

___

11. Duodenum:

No ___ Yes ___:

___

No ___ Yes ___:

___

No ___ Yes ___:

___

12. Stomach: th

th

th

13. 9 , 8 , 7 , 6 Section E:

th

thoracic:

Color Frequency: _____________

Total: ____

F. 1.

Internally conflicted:

No ___ Yes ___:

___

2.

Stagnated, blocked:

No ___ Yes ___:

___

3.

Adversarial:

No ___ Yes ___:

___

4.

Jealous, possessive:

No ___ Yes ___:

___

5.

Envious:

No ___ Yes ___:

___

6.

Internally conflicted:

No ___ Yes ___:

___

7.

Abandonment/separation:

No ___ Yes ___:

___

8.

Anger and sadness

No ___ Yes ___:

___

9.

Liver:

No ___ Yes ___:

___

10. Solar plexus:

No ___ Yes ___:

___

11. Blood:

No ___ Yes ___:

___

12. Gall bladder:

No ___ Yes ___:

___

No ___ Yes ___:

___

th

13. 5 , 4

th

thoracic:

Section F:

Color Frequency: _____________

© 2016 Extatica, Inc.

Total: ____

Orgasmic Energy Flow AssessmentTM www.extatica.com/InnerWild/

Page 4 of 7

G. Experienced problems or symptoms in this realm in last 6 months?

If YES, rank INTENSITY from 1 (mild) to 5 (extreme)

1.

Aloof:

No ___ Yes ___:

___

2.

Despondent, despairing:

No ___ Yes ___:

___

3.

Deprivation of affection /abandoned:

No ___ Yes ___:

___

4.

Vulnerable, hurt:

No ___ Yes ___:

___

5.

Destructive experiences of affection:

No ___ Yes ___:

___

6.

Loneliness:

No ___ Yes ___:

___

7.

Loss, grieving, empty:

No ___ Yes ___:

___

8.

Lungs:

No ___ Yes ___:

9.

Bronchial tubes:

No ___ Yes ___:

___

10. Breasts:

No ___ Yes ___:

___

11. Heart:

No ___ Yes ___:

___

No ___ Yes ___:

___

No ___ Yes ___:

___

12. Coronary arteries: 13. 3

rd

and/or 2

Section G:

nd

thoracic:

Color Frequency: _____________

Total: ____

H. 1.

Excessive intellectualization:

No ___ Yes ___:

___

2.

Detached, impersonal:

No ___ Yes ___:

___

3.

Lack of awareness of bodily No ___ Yes ___:

___

experience or emotions:

No ___ Yes ___:

___

5.

Moody:

No ___ Yes ___:

___

6.

Hypersensitive:

No ___ Yes ___:

___

7.

Emotional reasoning:

No ___ Yes ___:

___

8.

Esophagus, Trachea:

No ___ Yes ___:

___

9.

Thyroid gland:

No ___ Yes ___:

___

10. Forearms:

No ___ Yes ___:

___

11. Hands, Wrists, Fingers:

No ___ Yes ___:

___

12. Bursae in shoulders:

No ___ Yes ___:

___

13. 1st thoracic, 7th cervical:

No ___ Yes ___:

___

processes: 4.

Lack of awareness of inner

Section H:

Color Frequency: _____________

© 2016 Extatica, Inc.

Total: ____

Orgasmic Energy Flow AssessmentTM www.extatica.com/InnerWild/

Page 5 of 7

I. Experienced problems or symptoms in this realm in last 6 months?

If YES, rank INTENSITY from 1 (mild) to 5 (extreme)

1.

Introversion:

No ___ Yes ___:

___

2.

Inattentive:

No ___ Yes ___:

___

3.

Inarticulate:

No ___ Yes ___:

___

4.

Talk/don’t talk conflict:

No ___ Yes ___:

___

5.

Poor verbal communication:

No ___ Yes ___:

___

6.

Verbally abusive:

No ___ Yes ___:

___

7.

Quiet, shy:

No ___ Yes ___:

___

8.

Nose:

No ___ Yes ___:

___

9.

Outer ear:

No ___ Yes ___:

___

10. Tonsils, pharynx, vocal cords: No ___ Yes ___:

___

11. Mouth, lips, teeth, cheeks:

No ___ Yes ___:

___

12. Shoulders, neck muscles:

No ___ Yes ___:

___

No ___ Yes ___:

___

th

th

th

13. 6 , 5 , 4 , 3 Section I:

rd

cervical:

Color Frequency: _____________

Total: ____

J. 1.

Confusion, unable to think:

No ___ Yes ___:

___

2.

Inner conflict, indecisive:

No ___ Yes ___:

___

3.

Inability to think for oneself:

No ___ Yes ___:

___

4.

Feeling overwhelmed:

No ___ Yes ___:

___

5.

In denial, avoidant:

No ___ Yes ___:

___

6.

Confrontational thinking:

No ___ Yes ___:

___

7.

Sinuses:

No ___ Yes ___:

___

8.

Jaw, tongue:

No ___ Yes ___:

___

9.

Eyes, optic nerves:

No ___ Yes ___:

___

No ___ Yes ___:

___

11. Forehead, bones of the face:

No ___ Yes ___:

___

12. Pituitary gland, Brain:

No ___ Yes ___:

___

No ___ Yes ___:

___

10. Auditory nerves, Inner and middle ear:

nd

st

13. 2 , 1 cervical: Section J:

Color Frequency: _____________

© 2016 Extatica, Inc.

Total: ____

Orgasmic Energy Flow AssessmentTM www.extatica.com/InnerWild/

Page 6 of 7

K. Experienced problems or symptoms in this realm in last 6 months? 1.

Spacey:

2.

Mistrusting, paranoid,

If YES, rank INTENSITY from 1 (mild) to 5 (extreme)

No ___ Yes ___:

___

suspicious:

No ___ Yes ___:

___

3.

Worry:

No ___ Yes ___:

___

4.

Stubborn, obstinate:

5.

Magical thinking, delusionary: No ___ Yes ___:

___

6.

Aberrant or problematic spirituality:

7.

No ___ Yes ___:

___

Difficulty letting go, surrendering to events in reality:

No ___ Yes ___:

___

8.

Depression:

No ___ Yes ___:

___

9.

Alienation, social phobic:

No ___ Yes ___:

___

10. Senility:

No ___ Yes ___:

11. Hypothalamus:

No ___ Yes ___:

___

12. Cerebrospinal fluid:

No ___ Yes ___:

___

13. Top of skull:

No ___ Yes ___:

___

Section K:

Color Frequency: _____________

Total: ____

To interpret your Orgasmic Energy Flow Assessment, learn what the color frequency for each section is, and discover where blocks or kinks in your orgasmic energy flow may be, watch Video #2 of the “Unleash Your Inner Wild” video series at: www.UnleashYourInnerWild.com

This assessment was developed with my deepest appreciation for the groundbreaking work and teachings of my dear friend and mentor, Steven Vazquez, PhD., upon which it is largely and loosely based.

Ellen Eatough, MA The Soulful Sex Coach

© 2016 Extatica, Inc.

Orgasmic Energy Flow AssessmentTM www.extatica.com/InnerWild/

Page 7 of 7