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: