Questionnaire #1 - Acute for Bach Flower Essence Remedies

Please fill out this form and submit, then follow instructions given.

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1. Do you have vague fears which you cannot explain? Check only if you can give a definite "Yes" answer to this question.Yes
2. Do you often find yourself distressed and anxious, but are unable to put your finger on the problem? Check only if you can give a definite "Yes" answer to this question.Yes
3. Do you wake with a sense of apprehension and foreboding, feeling that something bad may happen, but don't know what it may be? Check only if you can give a definite "Yes" answer to this question.Yes
4. Do you have specific fears which you can identify and would like to overcome? Check only if you can give a definite "Yes" answer to this question.Yes
5. Are you shy and easily frightened by particular circumstances and things? Check only if you can give a definite "Yes" answer to this question.Yes
6. When faced with situations or things that frighten you, do you become nervous and too paralyzed to act? Check only if you can give a definite "Yes" answer to this question.Yes
7. Do you fear losing control of your mind or body? Check only if you can give a definite "Yes" answer to this question.Yes
8. Are you compulsive, or have impulses to do things you know are wrong but have difficulty controlling your actions? Check only if you can give a definite "Yes" answer to this question.Yes
9. Do you fear losing control and hurting yourself or others? Check only if you can give a definite "Yes" answer to this question.Yes
10. Do you worry over the health and safety of your friends and family? Check only if you can give a definite "Yes" answer to this question.Yes
11. Do you fear that something may happen to those close to you? Check only if you can give a definite "Yes" answer to this question.Yes
12. Does your over-concern and worry for others cause you considerable distress? Check only if you can give a definite "Yes" answer to this question.Yes
13. Do you suffer from extreme terror? Check only if you can give a definite "Yes" answer to this question.Yes
14. Do you tend to panic and become hysterical? Check only if you can give a definite "Yes" answer to this question.Yes
15. Are you troubled by nightmares? Check only if you can give a definite "Yes" answer to this question.Yes
16. Do you lack confidence in your ability to judge things on your own and make decisions? Check only if you can give a definite "Yes" answer to this question.Yes
17. Do you find yourself asking other people's advice, even when you know what you want? Check only if you can give a definite "Yes" answer to this question.Yes
18. After taking advice from others, do you find yourself confused by the choices, constantly changing your direction according to the latest recommendations? Check only if you can give a definite "Yes" answer to this question.Yes
19. Do you suffer from indecision, uncertainty or hesitancy? Check only if you can give a definite "Yes" answer to this question.Yes
20. Do you have difficulty choosing between one thing and another? Check only if you can give a definite "Yes" answer to this question.Yes
21. Do you experience extreme mood swings, or have difficulty in keeping your balance? Check only if you can give a definite "Yes" answer to this question.Yes
22. Are you dissatisfied with your current role in life, feeling that life is passing you by? Check only if you can give a definite "Yes" answer to this question.Yes
23. Have you tried many different directions in life, but nothing seems to bring satisfaction? Check only if you can give a definite "Yes" answer to this question.Yes
24. Would you like to find a new lifestyle, career or change your old one, but have difficulty deciding what you should be doing? Check only if you can give a definite "Yes" answer to this question.Yes
25. Do you lack confidence? Check only if you can give a definite "Yes" answer to this question.Yes
26. Do you not try things for fear of failing? Check only if you can give a definite "Yes" answer to this question.Yes
27. Do you feel inferior, and that others are more capable and qualified than you? Check only if you can give a definite "Yes" answer to this question.Yes
28. On rising in the morning, do you find yourself tired, not wanting to get up? Check only if you can give a definite "Yes" answer to this question.Yes
29. Do you feel some part of you needs to be strengthened before you can tackle the day? Check only if you can give a definite "Yes" answer to this question.Yes
30. Do you find once you have started your daily activities your tiredness is forgotten, and you're able to complete your task? Check only if you can give a definite "Yes" answer to this question.Yes
31. Are you absentminded, or does your attention easily wander, making it difficult to concentrate? Check only if you can give a definite "Yes" answer to this question.Yes
32. Do you find you have little interest in present circumstances, often daydreaming, wishing you were somewhere else? Check only if you can give a definite "Yes" answer to this question.Yes
33. Do you find yourself dozing off frequently, regardless of where you are? Check only if you can give a definite "Yes" answer to this question.Yes
34. Do you find you are caught between living in the present and dwelling in memories of the past? Check only if you can give a definite "Yes" answer to this question.Yes
35. Are there things you would like to have done with your life but never had the opportunity to do? Check only if you can give a definite "Yes" answer to this question.Yes
36. Do you find yourself reminiscing about the good old days, wishing you were able to live your life over again? Check only if you can give a definite "Yes" answer to this question.Yes
37. Do you find you are indifferent and apathetic toward life? Check only if you can give a definite "Yes" answer to this question.Yes
38. Are you resigned to your current circumstances, making little effort to improve things or find joy? Check only if you can give a definite "Yes" answer to this question.Yes
39. Do you feel you've given up and don't care one way or another what happens? Check only if you can give a definite "Yes" answer to this question.Yes
40. Do you find you can't sleep because your thoughts give you no rest? Check only if you can give a definite "Yes" answer to this question.Yes
41. Do you find your head full of persistent, unwanted thoughts that prevent concentration? Check only if you can give a definite "Yes" answer to this question.Yes
42. Do you relive unhappy event or arguments over and over again? Check only if you can give a definite "Yes" answer to this question.Yes
43. Do you find you don't learn from past experiences, repeating the same mistakes or patterns of behavior? Check only if you can give a definite "Yes" answer to this question.Yes
44. Due to lack of observation, do you find it necessary to go over things already done? Check only if you can give a definite "Yes" answer to this question.Yes
45. Is there a particular situation or condition continually recurring in your life which you would like to overcome? Check only if you can give a definite "Yes" answer to this question.Yes
46. Are you now going through, or have you recently gone through, an illness or personal ordeal which left you physically and mentally drained? Check only if you can give a definite "Yes" answer to this question.Yes
47. Do you tire easily with no reserve energy to complete your tasks or enjoy the day? Check only if you can give a definite "Yes" answer to this question.Yes
48. Do you feel sapped of strength and vitality, where even the least effort exhausts you? Check only if you can give a definite "Yes" answer to this question.Yes
49. Do others find you aloof, prideful and at times condescending? Check only if you can give a definite "Yes" answer to this question.Yes
50. Do you keep to yourself, not wishing to be interfered with or to interfere in other people's affairs? Check only if you can give a definite "Yes" answer to this question.Yes
51. Are you self-reliant? Do you prefer spending your time alone? Check only if you can give a definite "Yes" answer to this question.Yes
52. Do you find yourself losing patience, becoming tense and irritable with people and things that move too slowly for you? Check only if you can give a definite "Yes" answer to this question.Yes
53. Do you do things in a rush, racing from one place or situation to another? Check only if you can give a definite "Yes" answer to this question.Yes
54. Do you find you need to work alone, because others can't keep up to your pace? Check only if you can give a definite "Yes" answer to this question.Yes
55. Do you find others avoiding conversation with you because you tend to talk a great deal? Check only if you can give a definite "Yes" answer to this question.Yes
56. Do you dislike being alone and seek the company of anyone willing to listen to your troubles? Check only if you can give a definite "Yes" answer to this question.Yes
57. Do you feel the need to steer conversations back to your special interests or problems?Are you reluctant to discontinue them even when the listener has to leave? Check only if you can give a definite "Yes" answer to this question.Yes
58. When worried or in pain, do you tend to conceal it from others, making light of even the most trying of circumstances? Check only if you can give a definite "Yes" answer to this question.Yes
59. Do you go out of your way to avoid burdening others with your problems, giving in to the wishes of others in order to avoid an argument or quarrel? Check only if you can give a definite "Yes" answer to this question.Yes
60. When troubled, do you find yourself drinking alcohol, or using stimulants or drugs to assist in keeping up a happy disposition? Check only if you can give a definite "Yes" answer to this question.Yes
61. Are you easily imposed on because of your willingness to help others? Check only if you can give a definite "Yes" answer to this question.Yes
62. Is it difficult for you to say no when you're asked for help, becoming more a servant than a willing helper? Check only if you can give a definite "Yes" answer to this question.Yes
63. Do you neglect your own needs, because you are too busy taking care of other people's needs? Check only if you can give a definite "Yes" answer to this question.Yes
64. Are you involved in a relationship or situation you would like to be free of, but cannot break away from? Check only if you can give a definite "Yes" answer to this question.Yes
65. Are you currently in a state of transition or change? Check only if you can give a definite "Yes" answer to this question.Yes
66. In the midst of this change, do you find that you're having difficulty in letting go of past attachments or in starting new beginnings? Check only if you can give a definite "Yes" answer to this question.Yes
67. Are you suspicious and mistrusting of other people's motives and intentions? Check only if you can give a definite "Yes" answer to this question.Yes
68. Do others find you spiteful, envious, jealous or vengeful? Check only if you can give a definite "Yes" answer to this question.Yes
69. Do you find yourself lacking compassion or warmth toward others? Check only if you can give a definite "Yes" answer to this question.Yes
70. Are you rarely content with your accomplishments, feeling that you could always do better? Check only if you can give a definite "Yes" answer to this question.Yes
71. Do you blame yourself for other people's mistakes, feeling that their shortcoming are in some way your fault or responsibility? Check only if you can give a definite "Yes" answer to this question.Yes
72. Are you hard on yourself when you fail to live up to the standards or expectations you've set for yourself? Check only if you can give a definite "Yes" answer to this question.Yes
73. Do you tend to overextend your commitments? Check only if you can give a definite "Yes" answer to this question.Yes
74. Do you find yourself overwhelmed by your work, and despite being capable feel you have taken on more than you can do? Check only if you can give a definite "Yes" answer to this question.Yes
75. Do you become despondent when faced with the magnitude of your responsibilities? Check only if you can give a definite "Yes" answer to this question.Yes
76. Have there been past traumas or shocks in your life, which you may not have completely recovered from? Check only if you can give a definite "Yes" answer to this question.Yes
77. Do you feel a past surgery or accident is responsible for your present condition? Check only if you can give a definite "Yes" answer to this question.Yes
78. Have you recently, or in the past, suffered a personal loss which you haven't quite gotten over? Check only if you can give a definite "Yes" answer to this question.Yes
79. Do you feel you've reached the limits of your endurance, and there's nothing but annihilation left to face? Check only if you can give a definite "Yes" answer to this question.Yes
80. Do you suffer from mental anguish and deep despair? Check only if you can give a definite "Yes" answer to this question.Yes
81. Do you feel that the burden of life is more than you can bear? Check only if you can give a definite "Yes" answer to this question.Yes
82. Have you lost hope that you will recover from or be helped in overcoming an illness or difficulty? Check only if you can give a definite "Yes" answer to this question.Yes
83. Do you feel it is useless to seek further help for your problem? Check only if you can give a definite "Yes" answer to this question.Yes
84. Have you given up hope that things will change for the better in some circumstance or situation in your life? Check only if you can give a definite "Yes" answer to this question.Yes
85. Do you ever become gloomy and depressed for no known reason? Check only if you can give a definite "Yes" answer to this question.Yes
86. Does this depression envelope you like a dark cloud, hiding the joy of life? Check only if you can give a definite "Yes" answer to this question.Yes
87. Do you find this gloom and depression, for no apparent reason, lifts as suddenly as it comes? Check only if you can give a definite "Yes" answer to this question.Yes
88. Are you easily discouraged when things don't go your way? Check only if you can give a definite "Yes" answer to this question.Yes
89. When setting out to accomplish a task, do you become over-sensitive to small delays or hindrances which may lead to self-doubt, and at times to depression? Check only if you can give a definite "Yes" answer to this question.Yes
90. Is it hard for you to start over again once you've encountered difficulties? Check only if you can give a definite "Yes" answer to this question.Yes
91. Are you one who tirelessly struggles on despite oppositions and delays? Check only if you can give a definite "Yes" answer to this question.Yes
92. Can you always be depended on to complete what you set out to do, regardless of the challenge? Check only if you can give a definite "Yes" answer to this question.Yes
93. Do you tend to throw yourself into your projects neglecting your own needs, as well as the needs of those close to you? Check only if you can give a definite "Yes" answer to this question.Yes
94. Through no fault of your own, do you feel that life has been unfair or unjust to you? Check only if you can give a definite "Yes" answer to this question.Yes
95. Have you become resentful and bitter toward those who may have treated you poorly? Check only if you can give a definite "Yes" answer to this question.Yes
96. Despite all you have done, do you feel your best efforts have largely gone unrewarded, while others not as deserving as yourself, have gained? Check only if you can give a definite "Yes" answer to this question.Yes
97. Do you feel unclean or ashamed over an act you should not have committed, or over someone or something have violated you personally? Check only if you can give a definite "Yes" answer to this question.Yes
98. Do you find yourself preoccupied with small physical problems such as pimples, small blemishes or rashes, while overlooking more serious conditions? Check only if you can give a definite "Yes" answer to this question.Yes
99. Do you feel there is something wrong with, or some things you would like changed, in your physical appearance? Check only if you can give a definite "Yes" answer to this question.Yes
100. Are you compulsive about cleanliness, even at times to the extreme? Check only if you can give a definite "Yes" answer to this question.Yes
101. Are you afraid of becoming, or feel you have already become, contaminated and need to be cleansed? Check only if you can give a definite "Yes" answer to this question.Yes
102. Are you possessive of those close to you and feel you know what's best for them, often directing and correcting even small details of their lives? Check only if you can give a definite "Yes" answer to this question.Yes
103. Do you feel you are not appreciated by those you care for? Check only if you can give a definite "Yes" answer to this question.Yes
104. Do you find yourself needing the attention and devotion of those you love, feeling it's their duty to stay in close contact with you? Check only if you can give a definite "Yes" answer to this question.Yes
105. When assessing people and situations, do you look for what you can find wrong? Check only if you can give a definite "Yes" answer to this question.Yes
106. Do the small habits and idiosyncrasies of others bother you? Check only if you can give a definite "Yes" answer to this question.Yes
107. Are you critical and intolerant of those who don't measure up to your standards or expectations? Check only if you can give a definite "Yes" answer to this question.Yes
108. Do you have strong opinions which you attempt to convince others are right? Check only if you can give a definite "Yes" answer to this question.Yes
109. Are you easily incensed by injustices, arguing for and defending principles which you believe in? Check only if you can give a definite "Yes" answer to this question.Yes
110. Are you high-strung, at times tense and over-enthusiastic, always teaching and philosophizing? Check only if you can give a definite "Yes" answer to this question.Yes
111. Do you feel you have a mission in life to conform with or live up to? Check only if you can give a definite "Yes" answer to this question.Yes
112. Are you strict in your adherence to a religious or social discipline, or in a particular way of living? Check only if you can give a definite "Yes" answer to this question.Yes
113. Do you feel it's important to make an example of yourself by living up to your ideals, so that others may follow? Check only if you can give a definite "Yes" answer to this question.Yes
114. Do you tend to take charge in circumstances and situations you're involved with? Check only if you can give a definite "Yes" answer to this question.Yes
115. Are you strong-willed and expect complete obedience (without question) from those around you? Check only if you can give a definite "Yes" answer to this question.Yes
116. Do you consider yourself a "born leader?" Check only if you can give a definite "Yes" answer to this question.Yes
Is This Questionnaire for Someone Other Than Yourself? If you have filled this out for the benefit of another, this is perfectly fine. We would just like to know. Thanks.Yes