Affective Audio

To have custom Affective Audio created for your specific needs or desires, fill out this questionnaire as detailed as you'd like.
  • Name:
  • Email:
  • Date of birth (month/day/year, and clock time if you know):
  • City, state, country born:
  • Native language:
  • Heart rate (place your index and middle finger on the side of your neck just under your jaw. count the beats for one minute):
  • Gender:
    Male
    Female
  • What best describes your body type-- ectomorph/vata (thin), mesomorph/pitta(medium build), endomorph/kapha(heavy), or any combination please list:
  • With only a few adjectives, how would you best describes your temperament of the last few months (e.g. anxious, calm, nervous, focused, wild, etc.):
  • Describe the environment where you grew up (e.g. city, beach town, suburban, surrounded trees, near a lake, busy streets, etc.):
  • List a few of your favorite activities and/or hobbies:
  • List 3 to 5 favorite musical artists:
  • List 3 to 5 of your favorite songs:
  • In general, describe your current living situation (e.g. with one room-mate, calm, comfortable, noisy, mother with family, adolescent with family etc.):
  • In general, describe your current work situation (e.g. fast paced, overwhelming responsibilities, stressed, slow, boring, etc.):
  • In general, describe your current relations( e.g. intimate, fun, confusing, erratic, trusting, comfortable, etc.):
  • With a couple sentences, describe a currently repeating dilemma (1) / issue which needs to be addressed:
  • With a couple sentences, describe an ideal outcome or desired state for dilemma described above (1):
  • With a couple sentences, describe a second currently repeating dilemma (2) / issue which needs to be addressed:
  • With a couple sentences, describe an ideal outcome or desired state for dilemma described above (2):
  • With a couple sentences, describe an ideal life situation/aspiration/goal (this can be detailed or general):
  • In brief, describe 3 favorable situations you've experienced (could be anything from personal achievement to random situation and/or something you’ve observed):
  • List 3 things you find upsetting (this could be general or pertaining to an above issue stated within the questionnaire):
  • List 3 things you find enjoyable, liberating, and or soothing:
  • Are you experiencing repetitive dreams? If so, describe:
  • Are you experiencing specific pains, numbness, tingling, difficulty sleeping, difficulty breathing, flash backs, difficulty staying focused, compulsions, excessive substance use, abuse by physical, emotional or a sexual nature, allergies, mood disturbances, panic symptoms, and/or any other ailments-- if so, please list and describe:
  • Any other information you think may be pertinent, please explain: