Bach's Flower Remedies Questionnaire Form
Name
First Name
Last 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.
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