Bach Flower / Aromatherapy QuestionnaireBach Flower / Aromatherapy Questionnaire
To receive your own personalized Bach Flower or Aromatherapy Formula, check all the sentences that pertain to you presently.
I experience feelings of fear and/or terror over physical illness. I feel alarmed and panicky. Sometimes i freeze frozen from fear thoughts.
I fear pain, sufferings, poverty, and misfortune. I fear being alone. I tend to be shy.
I fear being out of control. Sometimes I feel powerless over my thoughts.
I fear I am losing my mind. Maybe I will explode or give way to my violent impulses.
I fear something terrible is going to happen at any time. I have many dreads.
I am obsessed with worry and concern for others, especially loved ones.
I doubt my own judgment and rely on others to advise me. I can't trust myself.
I can't decide between things. Making a decision is too hard for me. I suffer from mood swings. I have so much uncertainty.
I become easily discouraged and depressed by setbacks in my life.
I tend to be pessimistic. What's the use? There's no hope for me anyway. Nothing seems to work for me.
It's a struggle to complete my tasks. I procrastinate too often.
I have a lack of direction. Life is passing me by. What's my calling in life?
I feel absent minded, inattentive, and walk around in a dreamy state.
I know my future will never be as happy as my past. I tend to be nostalgic.
I lack motivation. I suffer from apathy and resignation. It's the way it is.
Feelings of mental/physical exhaustion. Everything in life is such an effort. No joy.
I am plagued by persistent, unwanted thoughts day & night. No concentration.
I suffer attacks of gloom & despair. Feels like a dark cloud descends on me.
I must learn the same lesson over & over again. I fail to learn from experience.
To others I appear aloof, withdrawn, and proud. I bear my grief in silence. I'm independent and I don't need to share my problems and concerns with others.
I'm impatient, irritable, and always rushing ro push things through. I work alone.
I tend to talk incessantly, totally self-absorbed with my own problems. I need an audience and hate being alon. People usually avoid me because I sap their energies.
I conceal worries behind smile, drugs, and/or alcohol. I'd rather give in than fight.
Can't say no - even though I want to. Put others' needs before my own. I'm shy.
Need to break away from the strong forces that distract & influence me. I'm going through a change (puberty, menopause, new move, new job, etc.). I am easily diverted by the opinions of others.
Thoughts of jealousy, envy, revenge, suspicion, mistrust, anger, and hatred.
Lack self-confidence. Feel inferior. I know I will fail - so why even try?
I feel guilty. I know I can do better. It's all my fault. I am always apologizing.
Overwhelmed with responsibilities, feelings of inadequacy. Too much to do.
Mental anguish. I can't endure any more, there's no future ahead for me.
I have suffered a trauma/shock in my life (loss of a loved one, accident, etc.).
Feel resentments, bitterness. Can't forgive. I can't let go. "poor me" I grumble.
I must struggle one. I have a deep sense of duty & dependability. Over-achiever.
Obsessed with cleanliness and trivialities. I have self-disgust and am ashamed of my ailments. If only I get rid of this I know I will be alright.
I'm possessive, manipulative. I need to be needed. I'm clingy & over-protective.
Tend to be fanatical, tense, high strung, when I'm right - I'm right!
Inflexible, ambitous, need to be right. Proud, domineering, & overbearing.
Overly critical, intolerant, you're right & everyone else is wrong. Perfectionist.
I try to set an example for others by denying myself joys & pleasures. I'm a hard task master, opinionated, rigid ideals, inflexible, and I strive for perfection.
Thank you!
Mail your completed questionnaire and a check or money order for $25.00 to:
Reiki Center of Venice
PO Box 554
Venice, Florida 34284-0554
(941) 497-7795
email: revreikind@cs.com
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