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Check the box next to the questions you feel strongly apply to you at this moment. Printer Friendly Version 1. AGRIMONY Do you hide your worries behind a cheerful, smiling face to conceal your pain from others? Are you distressed by arguments and quarrels, often "giving in" to avoid conflict? When you feel life's pressures weighing you down, do you often turn to food, work, alcohol, drugs, or other outside influences to help you cope? 2. ASPEN Do you have feelings of apprehension or anxiety without knowing why? Do you feel that something bad may happen but you are not sure what? Do you wake up with a sense of anxiety of what the day will bring? 3. BEECH Are you annoyed by the habits and shortcomings of others? Do you find yourself to be overly critical and intolerant, usually looking for what someone has done wrong and not right? Does the incompetence and foolishness of others irritate you? 4. CENTAURY Do you often neglect your own needs in order to please others? Is it difficult to say no to those who impose on your good nature? Do you tend to be easily influenced by those stronger in nature than yourself? 5. CERATO Do you constantly second-guess your own decisions and judgement? Do you often seek advice and confirmation from other people, mistrusting your own intuition? Do you change direction often, even after asking advice, because you feel confused or unsure? 6. CHERRY PLUM Are you afraid you might lose control of yourself mentally, emotionally, or physically? Do you fear that you may think or do something that you feel is wrong? Do you fear you may hurt yourself or others or become violent and explosive? 7. CHESTNUT BUD Do you find yourself making the same mistakes over and over again, such as choosing the wrong type of partner or staying in a job you dislike? Do you fail to learn from the mistakes and/or experience of others? Do you wish you would not repeat the same patterns again and again? 8. CHICORY Do you need to be needed and want your loved ones to be close by? Do you feel unloved and unappreciated by your loved ones? Are you possessive of those you care for, feeling you know what is best for them? 9. CLEMATIS Do you often feel spacey and absent-minded? Do you find yourself preoccupied and dreamy, unable to concentrate for any length of time? Are you drowsy and listless, sleeping more often than necessary? 10. CRAB APPLE Are you obsessed with cleanliness or feel toxic or contaminated? Are you embarrassed and ashamed of yourself or feel physically unattractive? Do you tend to concentrate on small physical conditions such as pimples or marks? 11. ELM Do you feel overwhelmed by your resposibilities? Do you feel it is too difficult to handle all the many tasks ahead of you? Do you become depressed and exhausted when faced with your everyday commitments? 12. GENTIAN Do you become discouraged and depressed when things go wrong? Are you easily disheartened when faced with difficult situations? Does your depressed attitude prevent you from making an effort to accomplish something? 13. GORSE Do you feel hopeless, as if there is no reason to try to improve things? Do you lack faith that things could get better in your life and therefore make no effort to improve your circumstances? Do you beleive that nothing can be done to relieve your pain and suffering? 14. HEATHER Do you find that others may avoid you because you seem to talk too much? Do you dislike being alone, always seeking the companionship of others, to have someone to talk to? Do your conversations usually wind up focusing on your interests or problems? 15. HOLLY Are you suspicious of others, feeling that people have "ulterior motives"? Do you feel great anger toward other people? Are you full of jealousy, mistrust, or hate? 16. HONEYSUCKLE Do you find yourself living in the past, nostalgic and homesick for the "way it was"? Are you unable to change present circumtances because you are always looking back and never forward? Do you often contemplate past regrets? 17. HORNBEAM Do you often feel too tird to face the day ahead? Do you feel overworked or bored with your life? Do you tend to procrastinate and put off some tasks while easily accomplishing those that are more enjoyable? 18. IMPATIENS Do you feel a sense of urgency in everythings you do, always rushing to get through things? Are you impatient and irritable with others who seem to do things too slowly for you? Do you prefer to work alone? 19. LARCH Do you lack self-confidence? Do you feel inferior and often become discouraged? Are you so sure that you will fail that you do not even attempt things? 20. MIMULUS Do you have fears of identifiable things, i.e., illness, death, pain, heights, darkness, the dentist, etc.? Are you shy, overly sensitive, and often afraid? Do you often worry about everyday situations, i.e., traffic, bills, etc.? 21. MUSTARD Do you feel depressed without knowing why? Do you feel your moods swinging back and forth? Do you feel deep gloom, which seems to quickly appear for no apparent reason and then lifts just as suddenly? 22. OAK Are you exhausted but feel the need to struggle on against all odds? Do you have a strong sense of duty and dependability, carrying on no matter what obstacles stand in your way? Do you neglect your own needs in order to complete a task? 23. OLIVE Do you feel uttery and completely ehausted, both physically and mentally? Are you totally drained of all energy with no reserves left, finding it difficult to carry on? Have you just been through a long period of illness, stress, or strain with no relief? 24. PINE Do you set overly high standards for yourself, never satisfed with your achievements? Are you full of guilt and self-reproach? Do you blame yourself for everything that goes wrong, sometimes even the mistakes of others? 25. RED CHESTNUT Are you often concerned and worried about your loved ones? Are you distressed and disturbed by other people's problems? Do you worry that harm may come to those you care for? 26. ROCK ROSE Are you susceptible to feelings of terror and panic? Do you become helpless and frozen in the face of your fear? Do you suffer from nightmares? 27. ROCK WATER Do you set high personal standards and take pride in setting a good example for others? Are you overly concerned with diet, exercise, work, and spiritual disciplines? Are you extremely disciplined in your approach to life, always striving for perfection? 28. SCLERANTUS Do you find it difficult to decide when faced with a choice of two possibilities? Do you lack concentration, always fidgety and nervous? Do your moods change from one extreme to another: joy to sadness, optimism to pessimism, laughing to crying? 29. STAR OF BETHLEHEM Have you suffered a recent shock in your life such as an accident, loss of a loved one, terrible new, illness? Are you numbed or withdrawn because of tramatic events in your life? Have you suffered a loss or grief from which you have never recovered? 30. SWEET CHESTNUT Do you suffer from extreme mental or emotional anguish? Do you feel you have reached the limits of what you could possibly endure? Do you feel as though there is no light at the end of the tunnel? 31. VERVAIN Do you have so much energy and drive, that you're sometimes tense and can't fall asleep? Do you have strong opinions and try to convince others of them? Are you sensitive to injustice and dedicated to causes almost to the point that others think is extreme? 32. VINE Do you tend to take charge of meetings, projects, situations, etc.? Do you consider yourself a natural leader? Are you strong-willed and ambitious but may appear aggressive and domineering to others? 33. WALNUT Are you experiencing any change in your life -- a move, new job, loss of someone loved, new relationship, divorce, menopause, giving up an addition? Do people or situations sometimes drain your energy? Do you need to make a break from strong forces or attachments in your life that may be holding you back? 34. WATER VIOLET Do you appear to others to be aloof or overly proud? Do you have a tendency to be withdrawn and prefer to be alone when faced with too many external distractions? Do you bear your grief and sorrow without talking to others? 35. WHITE CHESTNUT Do you find your head full of persistent, unwanted thoughts that prevent concentration? Do you relive unhappy events or arguents over and over again? Are you unable to sleep at times because your mind seems to be cluttered with mental arguments that go round and round? 36. WILD OAT Do you find yourself in a complete state of uncertainty over major life decisions? Do you feel ready for a change of direction, but are unsure which way to go? Do you have ambition but feel that life is passing you by? 37. WILD ROSE Are you apathetic and resigned to whatever may happen in your life? Do you have the attitude, "it doesn't matter anyhow"? Do you lack the motivation to improve the quality of your life? 38. WILLOW Do you feel resentful and bitter? Do you have difficulty forgiving and forgetting? Do you feel life is unfair and find yourself taking less interest in the things you used to enjoy? Natural Approach Acupuncture and Massage 1101 West Hibiscus Blvd Suite #105 Melbourne, FL 32901 (321)725-2438