Emotional Survey




  • Did your health problem occur after a traumatic experience?
  • YES
Do you feel? Do You Now Feel… What % of Time You Feel
This Way?
1. Irritated? YES %
2. Resentment? YES %
3. Shock-Trauma? YES %
Unrequited Love? YES %
Overwhelmed? YES %
Guilt? YES %
4. Fear? YES %
5. Stuck? YES %
6. Anger? YES %
Frustration? YES %
7. Grief? YES %
8. Vulnerable? YES %
9. Low Self-esteem? YES %
Rejection? YES %
10. Disgust? YES %
Despair? YES %
11. Confusion? YES %
Paranoia? YES %
12. Male – Reproductive? YES %
Unresponsive? YES %
13. Female – Reproductive? YES %
Unresponsive? YES %

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