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Natural Health for Fertility.com

Bach Flower Therapy Online

Bach Flower Therapy Assessment (Male Fertility)

Your mental and emotional state can affect male fertility health. If you suffer from low sperm count, poor sperm morphology, and male related infertility issues and feel mentally, emotionally and physically down as a result.

Bach Flower Therapy Can Help You!

If you are going through an emotionally difficult time in your life or your stressful life style is affecting you chances of becoming a father, the following Online Bach Flower Assessment for Male Fertility will be able to give you the support you need. After submitting your online questionnaire, you will receive the following:

1. Your comprehensive personalized Bach Flower Essence Report.

2. How to use Bach Flower Essences.

3. A personalized list of "Affirmations and Intentions" that will assist you in releasing negative emotions and acquire new life skills and a positive outlook.

4. How to journal your emotions to keep track your progresses.

5. How and where to purchase your Bach Flower Remedies online. Most are available at your local homeopathic pharmacy or health food store.

6. Email support of a maximum of three confidential emails during the course of first month period from the purchase date.

Please complete the following Bach Flower Therapy Online Assessment.

After you click on the submit button, you will be asked to provide the payment
of $45.00 USD through PayPal.

You can Pay directly from your PayPal balance or linked bank account. Or charge it to your credit card.

If you expereince any problems, please contact us.

Online Questionnaire
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-mail Address*
Street Address*
City*
State/Prov*
Zip/Postal Code*
Country*
Home Phone*
Age*
Occupation*
Marital Status*
Number of Children:*
Describe the condition or situation which you would like to change with the help of Bach Flower Therapy (include as many details as possible by expressing how you feel emotionally):*
Only select the circumstance that apply to you:
1. I keep my worried feelings bundled up inside and I put on a happy face.
2. Nobody knows my problems, they think I am always a jolly person.
3. I dislike arguments and often give in to avoid conflict.
4. I turn to food, work, alcohol, drugs, etc. when down, feel pressured or stressed to help me cope.
5. I feel anxious and apprehension without knowing why.
6. I have a fear that something bad will happen day and night, but I do not tell anyone.
7. I wake up feeling anxious because I am afraid of the unknown.
8. I constantly worry and I do know why.
9. I get annoyed by the habits of others and their inadequacy.
10. I can be critical on others' mistakes (what they have done wrong).
11. I am irritated and annoyed by others ineffectiveness at work.
12. I have no use for incompetent people. Certain people that will never learn. They are useless!
13. I often neglect my own needs to please others.
14. I find it difficult to say "no" when I should.
15. Friends, coworkers and family members always take advantage of my good nature.
16. I tend to be easily influenced by those with a stronger nature than mine.
17. I constantly second-guess myself.
18. I am never sure of my own decisions no matter how easy.
19. I seek advice and confirmation from others, mistrusting my own instinct.
20. I often change my mind often out of confusion, when I should have follow my own intuition.
21. I'm afraid I might lose control of myself (mentally, emotionally or physically).
22. I have sudden fits of rage. I fear that I might do something wrong.
23. I fear I might hurt myself, others or become violent out of sudden negative impulse.
24. My mind is over-strained, I might not be able to control myself. I feel like I am going crazy.
25. I feel like I keep making the same type of mistakes over and over in my life.
26. I seem to always end up choosing the wrong type of friends, life partner, career, etc.
27. I seem to fail to learn from my experiences or mistakes.
28. I keep repeating the same patterns.
29. I feel better when I am needed and always want my loved ones close to me.
30. I feel unloved and unappreciated by my family.
31. I easily feel upset and hurt by others who do not appreciate my affords.
32. I live for my loved ones. I smother them and they should tell me how much they love me.
33. I like to daydream. People think I am absent minded. That's just me!
34. I find myself unable to concentrate for long periods of time. My mind often just slips off to something else.
35. I get drowsy and sleepy more than necessary.
36. I am a quiet person and I am not really happy in my current situation. I like to fantasies about a better future.
37. I am overly concerned with cleanliness. I wash my hands frequently and my home has to be tidy.
38. I notice every imperfection of my body and I wish I could change it. I feel physically unattractive even if people tell me otherwise.
39. I tend to obsess over little things.
40. I feel in need of mental, emotional and physical cleanse.
41. I feel overwhelmed by my responsibilities. I am quite capable but I just have too much on my plate.
42. I don't cope well under pressure.
43. I have temporarily lost my self-confidence and I feel depressed when things get too difficult.
44. I like to help others but I just cannot do it all.
45. I become easily discouraged.
46. Every small delay makes me doubt the outcome even if things are going well overall.
47. I am easily disheartened when faced with difficulties.
48. I am often doubtful and pessimistic. People tell me I should be more positive.
49. I feel hopeless, and can't see a way out. I do not see what else I can do.
50. I lack faith that things could get better in my life. In a way I feel like I am giving up.
51. I feel gloomy and depressed with very little or no hope.
52. I am going through things just because my loved one have convinced me, to make them happy, but nothing is working for me.
53. I am obsessed with my own troubles and affairs. I cannot stop thinking and talking about them.
54. I dislike being alone and I like to talk. I feel better when I can tell others about my things.
55. When I am talking to someone I usually bring conversations back to myself.
56. I feel the need to share my life events. I even talk to strangers (anyone willing to listen) about my affairs.
57.I am suspicious of others. I do not trust people that are too nice.
58. I feel discontented and unhappy with my life. Everyone else seems to have it easier.
59. I am often jealousy when others have what I want.
60. I hate people who get everything in their life.
61. I'm often homesick for the way things used to be. I often talk about my childhood or my home town, and my family.
62. I find myself thinking more about the past than the present. I used to be happier. If only things could be like back then...
63. I often think about what might have been, some of my ambitions or dreams might have come true.
64. I miss my family. I often thing of going back home.
65. I often feel too tired to face the day ahead. I have lost my enthusiasm.
66. I feel mentally exhausted. I have very little strength to carry out my tasks. I get things done eventually.
67. I tend to put things off and procrastinate a lot because I feel weak and drained.
68. I get up in the morning and I wish I could crawl back to bed. I need a break!
69. I find it hard to wait for things to happen. I wish tomorrow was today!
70. I am impatient and irritable every time I am waiting for something to happen.
71. I prefer to work alone, people slow me down. I seem to think faster and quicker than others.
72. I lack self-confidence.
73. Everyone else is more capable than I am.
74. I feel inferior and often become discouraged. That's why I do not persue my dreams.
75. I always expect failure. What is the sense of working hard when I know I will not get what I want.
76. I am a fearful type of person. I am afraid of many things such as spiders, poverty, accidents, illness, germs, medical procedures, dark, thunderstorms, rats, etc.
77. I am shy and feel insecure when i meet new people.
78. I am overly sensitive, and modest.
79. I often get nervous and embarrassed.
80. I am reserved and rather be by myself and do not share my real fears with others.
81. I get depressed without any reason.
82. I am sad like a dark cloud over me all the time.
83. I get sudden gloomy feelings that come and go.
84. I am rarely happy or cheerful. I almost never feel the need to smile or laugh.
85. I tend to overwork and keep on in spite of exhaustion. I have a strong sense of duty.
86. People think I am brave and a fighter against great difficulties and never lose hope.
87. I neglect my own needs in order to complete a task. I keep on going.
88. When sick I really try hard to get well. I never give up.
89. I feel completely exhausted, physically and/ or mentally.
90. I am totally drained of all energy with no reserves left.
91. I have just been through a long period of illness or stress.
92. Because I am so tired I cannot enjoy my life, every day feels like hard work just to keep alive.
93. I blame myself for many things that happen in my life especially when things go wrong.
94. I have such a great sense of guilt that I feel responsible for someone else's mistakes.
95. I cannot enjoy when I succeed because I think about what I could have done better.
96. I am a hard-working person but I am never satisfied of my affords or results.
97. I am overly concerned and worried about my loved ones.
98. I am constantly worried about my child, mother, spouse, sister, brother, etc.
99. I am distressed and disturbed by other people's problems.
100. I worry that harm may come to those I love.
101. I sometimes feel sudden strong sense of terror and panic.
102. I become helpless and frozen when afraid during a traumatic situation or illness.
103. I suffer from nightmares. I wake up screaming or crying.
104. I have suffered a traumatic event in my life that left me very fearful from which I never fully recovered.
105. I set high standards for myself.
106. I am strict with my diet, exercise routine, work, school, etc.
107. I am very dedicated, self-disciplined, always striving for perfection and I like to be an example to others.
108. I rarely give myself a break. I have too much work to do.
109. I find it difficult to make decisions.
110. I often change my mind and opinions because I feel insecure.
111. I have intense mood swings.
112. I cannot decide between two thinks. I keep debating in my mind but never make a decision.
113. I feel devastated due to a recent shock (bad news, divorce, accident, loss of a loved one, etc.)
114. I am withdrawn and reserved due to traumatic events in my life.
115. I have never recovered from loss or fright.
116. I am in deep grief for a recent event or I am still grieving from a past event and I cannot let go.
117. I feel extreme mental or emotional despair very often.
118. I have reached the limits of my endurance.
119. I do not see a way out. I feel like my end is near.
120. I am in complete despair, all hope is gone.
121. I get high-strung and very intense.
122. I try to convince others of my way of thinking, my beliefs and ideals.
123. I am sensitive to injustice, almost fanatical. I need to stand out for those who can't.
124. I am very involved in my cause (environment, social justice, world peace, orphans of war, etc.)
125. I tend to take charge of projects, situations, etc. I like to be in charge of things.
126. I consider myself a natural leader. I am confident of my ability and my success.
127. I am strong-willed, ambitious and people tell me that I am bossy.
128. I am always assure of myself and know how to handle difficult situations, emergencies, etc.
129. I am experiencing change in my life (new baby, move, new job, divorce, etc.)
130. I get drained by people or situations. I am easily influenced and feel vulnerable.
131. I want to be free to follow my own ambitions.
132. Strong opinions from others may take me away from following and fulfilling my life goals.
133. I give the impression that I'm unfriendly.
134. I prefer to be alone when overwhelmed.
135. I often don't connect with people.
136. I am constantly thinking unwanted thoughts.
137. I relive unhappy events or arguments over and over again.
138. I am unable to sleep at times because I can't stop thinking.
139. I cannot turn off the constant chatter in my mind.
140. I can't find my path in life.
141. I am drifting in life and lack direction.
142. I am ambitious but don't know what to do. I do not know what occupation to follow.
143. I know I am destined for great things. I just do not know How to get them.
144. I am apathetic and resigned to whatever happens.
145. I have the attitude, "It doesn't matter anyhow".
146. I feel no joy in life and I do not do anything to change it. What's the sense?
147. I surrender to my struggles. I just get through my days without care.
148. I feel resentful and bitter as a result of what I had to go through in the past.
149. I have difficulty forgiving and forgetting.
150. I think life is unfair.
Please describe how your mental and emotional balance changes during times of stress:*
Only select the circumstance that apply to you:
1. I often have self doubt and hesitation about my sexual abilities.
2. I feel a sense of rejection at the thought that my lover might not enjoy sex with me.
3. I am disgusted at the thought of certain type of sexual behaviours.
4. Since we have been trying to conceive I feel discouraged and I think we should give up and go back to the way things were before.
5. My wife tells me that I do not listen to her needs in the bedroom and that It is all about me.
6. I wish I was a better lover but I do not think I can.
7. I am fearful we will never get pregnant.
8. I am fearful of having to go through fertility testing.
9. I put on a happy face for my partner but inside I am worried that I am infertile.
10. I wish we could do things differently while having sex but I am hesitant to say anything because I am afraid my wife's feelings will be hurt.
11. I am worried about my wife's having to go through a pregnancy.
12. I have difficulty sleeping at night because I keep thinking with constant worrying and oppressive unwanted thoughts.
13. I feel guilty because it is my fault that we cannot conceive.
14. My sperm is the problem and I feel it is my fault because of things I might have done to cause this situation.
15. I feel we should try harder and do our best to get pregnant naturally. I am following a very strict diet and life style.
16. I am stressed and overworked because I take on too much responsibility. Until now I was able to handle everything, but now I feel I have too many commitments.
17. I am a hard working men and I know I keep too busy but I keep on carrying on anyways.
18. I have difficulty relaxing because I cannot say no to my job's demands and I end up doing more work than I should. Often everybody else's job too!
19. I am very passionate about my interests and I spend way too much time on them.
20. Everyone I know has fathered I child but myself. I feel life is always harder on me.
21. I feel it is taking too long to get pregnant. I wish my wife was pregnant now!
I understand that the information provided during this Bach Flower Therapy Assessment will be held in strict confidence. I further understand that the information I receive as a result of this Bach Flower Therapy Assessment is for educational purposes only. No information provided is intended to diagnose, treat or cure any disease or condition. Said information is not to be interpreted as a substitution for, or an addition to, medical advice, opinions, or treatment from a qualified physician. I agree to hold www.natural-health-for-fertility.com and its team harmless from any and all claims and from any and all loss, damage, liability or expense, including cost of suit and attorney's fees, resulting from or arising out of my use of said information for the above mentioned purposes. *
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Date: (MM/DD/YYYY):*

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