www.MarysReflexology.com - Bach Flower Questionnaire

The Original Bach Flower Remedies are a natural system of healing.

Dr. Edward Bach discovered that flowers in nature have the ability to affect our emotions positively. The energies from different flowers can remove our emotional pains and suffering, which over time harm our health and impair healing.

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Date*

Date

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Name*

First NameLast Name

Email (Results to this email address)*

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INSTRUCTIONS

Check each statement that describes how you feel
SUBMIT

I often hide my feelings behind a facade of cheerfulnessI dislike arguments and often give in to avoid conflictI turn to food, work, alcohol, drugs, etc. when down

I feel anxious without knowing whyI have a strange fear that something bad will happenI wake up feeling anxious

I easily get annoyed by the habits of othersI often focus on others peoples mistakesI find myself being critical and intolerant of others

I often neglect my own needs to please othersI find it difficult to say "no"I tend to be easily influenced

I constantly second-guess myselfI seek advice, mistrusting my own intuitionI often change my mind out of confusion

I'm afraid I might lose control of myselfI have sudden fits of rageI feel like I'm going crazy

I make the same mistakes over and overI don't learn from my experienceI keep repeating the same wrong patterns

I need to be needed and want my loved ones closeI feel unloved and unappreciated by my familyI easily feel slighted and hurt

I often feel spacey and absent mindedI find myself unable to concentrate for longI get drowsy and sleep more than necessary

I am overly concerned with cleanlinessI feel unclean or physically unattractiveI tend to obsess over little things

I feel overwhelmed by my responsibilitiesI don't cope well under pressureI have temporarily lost my self-confidence

I become discouraged with small setbacksI am easily disheartened when faced with difficultiesI am often skeptical and pessimistic

I feel hopeless, and can't see a way outI lack faith that things could get better in my lifeI feel sullen and depressed

I am obsessed with my own troublesI dislike being alone and I like to talkI usually bring conversations back to myself

I am suspicious of othersI feel discontented and unhappyI am full of jealousy, mistrust, or hate

I'm often homesick for the "way it was"I think more about the past than the presentI often think about what might have been

I often feel too tired to face the day aheadI feel mentally exhaustedI tend to put things off and may procrastinate

I find it hard to wait for thingsI am impatient and irritableI prefer to work alone

I lack self-confidenceI feel inferior and often become discouragedI never expect anything but failure

I am afraid of things such as spiders, illness, etc.I am shy, overly sensitive, and modestI often get nervous and embarrassed

I get depressed without any reasonI feel my moods swinging back and forthI get gloomy feelings that come and go

I tend to overwork and keep on in spite of exhaustionI have a strong sense of duty and never give upI neglect my own needs in order to complete a task

I feel completely exhausted, physically and/ or mentallyI am totally drained of all energy with no reserves leftI have just been through a long period of illness or stress

I feel unworthy and inferiorI often feel guiltyI blame myself for everything that goes wrong

I am overly concerned and worried about my loved onesI am distressed and disturbed by other people's problemsI worry that harm may come to those I love

I sometimes feel terror and panicI become helpless and frozen when afraidI suffer from nightmares

I set high standards for myselfI am strict with my health, work &/or spiritual disciplineI am very self-disciplined, always striving for perfection

I find it difficult to make decisions when I have 2 optionsI often change my opinionsI have intense mood swings

I feel devastated due to a recent shockI am withdrawn due to traumatic events in my lifeI have never recovered from loss, trauma or fright

I feel extreme mental or emotional heartacheI have reached the limits of my enduranceI feel complete despair, all hope gone

I get high-strung and very intenseI try to convince others of my way of thinkingI am sensitive to injustice, almost fanatical

I tend to take charge of projects, situations, etc.I consider myself a natural leaderI am strong-willed, ambitious and often bossy

I am experiencing change in my life; a move, new job, etc.I get drained by people or situationsI want to be free to follow my own ambitions

I give the impression that I'm aloofI prefer to be alone when overwhelmedI often don't connect with people

I have repeated unwanted thoughts and worriesI relive unhappy events or arguments over and over againI am unable to sleep at times because I can't stop thinking

I can't find my path in lifeI am drifting in life and lack directionI am ambitious, but don't know what to do

I am apathetic and resigned to whatever happensI have the attitude, "It doesn't matter anyhow"I feel no joy in life

I feel resentful and bitterI have difficulty forgiving and forgettingI think life is unfair and have a "Poor me attitude"

How was your experience with the questionnaire?

The result of the result Questionnaire will arrive shortly by email.

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This form serves only as a suggestion. Learn more about the remedies before you take them at www.BachFlower.com and in the document that will arrive attached to your result email.

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Mary's Reflexology