Bach's Flower Remedies Questionnaire Form

Bach's Flower Remedies Questionnaire Form
Name

First NameLast Name
Email*
example@example.com (results will be sent here)
Please answer honestly and check off all that apply:

I often hide my feelings behind a facade of cheerfulness.I dislike arguments and often give in to avoid conflict.I turn to food, alcohol, drugs, etc. when feeling down.I feel anxious without knowing why.I have a strange fear that something bad will happen.I wake up feeling anxious.I easily get annoyed by the habits of others.I often focus on other peoples mistakes.I find myself being critical and intolerant of others.I often neglect my own needs to please others.I find it difficult to say "no."I tend to be easily influenced.I constantly second guess myself.I seek advice, mistrusting my own intuition.I often change my mind out of confusion.I'm afraid I might lose control of myself.I have sudden fits of rage.I feel like I am going crazy.I make the same mistakes over and over.I don't learn from my mistakes.I keep repeating the same negative patterns.I need to be needed and want my loved ones close.I feel unloved and unappreciated by my family.I easily feel slighted and hurt.I often feel spacey and absentminded.I find myself unable to concentrate for long.I get drowsy and sleep more than necessary.I am overly concerned with cleanliness.I feel unclean or physically unattractive.I tend to obsess over small things.I feel overwhelmed by my responsibilities.I don't cope well under pressure.I do not feel self-confident.I become discouraged with small setbacks.I am easily disheartened when faced with difficulties.I am often skeptical and pessimistic.I feel hopeless and can't see a way out.I lack faith that things could get better in my life.I feel sullen and depressed.I am obsessed with my own troubles.I dislike being alone and I like to talk.I usually bring conversations back to myself.I am suspicious of others.I am discontent and unhappy.I am full of jealousy, mistrust or hate.I am often homesick for "the way things once were."I think more about the past than the present.I often think about what might have been.I often feel too tired to face the day ahead.I feel mentally exhausted.I tend to put things off and may procrastinate.I find it hard to wait for things.I am impatient and irritable.I prefer to work alone.I lack self-confidence.I feel inferior and often feel discouraged.I never expect anything but failure.I am afraid of things such as spiders, heights, illness, etc.I am shy, overly sensitive and modest.I often get nervous and embarrassed.I get depressed without any reason.I feel my moods swing back and forth.I get gloomy feelings that come and go.I tend to overwork but keep going in spite of exhaustion.I have a strong sense of duty and never give up.I neglect my own needs to complete a task.I feel exhausted physically and/or mentally.I am often totally drained of all my energy.I have recently been through a long period of illness and/or stress.I feel unworthy and inferior.I often feel guilty.I blame myself for everything that goes wrong.I am overly concerned about my loved ones.I am distressed and disturbed by other people's problems.I worry that harm may come to those I love.I sometimes feel terror and panic.I become helpless and frozen when afraid.I suffer from nightmares.I set high standards for myself.I am strict with my work, health and/or spiritual discipline.I am very self-disciplined, always striving for protection.I find it difficult to make decisions when I have two or more options.I often change my opinions.I have intense mood swings.I feel devastated due to a recent event/situation.I am withdrawn due to traumatic events in my life.I have losses, traumas or fears from which I have never recovered.I feel extreme mental or emotional heartache.I have reached the limits of my endurance.I feel complete despair, all hope is gone.I get high-strung and very intense.I try to convince others of my way of thinking.I am extremely sensitive to injustice.I tend to take charge of projects or situations.I consider myself a natural leader.I am strong-willed, ambitious and often bossy.I am currently experiencing change in my life. (new job, a move, etc)I feel drained by people or situations.I want to be free to follow my own ambitions.I give the impression that I am aloof.I prefer to be alone when overwhelmed.I often don't connect with people.I have repeated unwanted thoughts and worries.I relive unhappy events or arguments over and over.I am unable to sleep at times because I cannot stop thinking.I can't find my path in life.I am often drifting through like and lack direction.I am ambitious but don't know what to do.I am apathetic and resigned to whatever happens.I have the attitude, "It doesn't matter anyway."I don't feel joy in life.I feel resentful and bitter.I have difficulty forgiving and forgetting.I think life has been unfair to me.I have experienced a major trauma.I feel extremely stressed out.I feel irritated and impatient.I feel spacey and not grounded.I feel I may lose control.I feel frightened and frozen.
Should be Empty: