Customised Flower Essence Formula

Please take the time to complete this form for the creation of your own customised Bach Flower Essence Formula.

Your primary focus here is to be honest of your current emotional state and feelings, but also whatever may be there longstanding.

Avoid overthinking - Go with what comes first.

You may find yourself already feeling a shift once you've finished. That's because you did half the job just by bringing it to light.

- First it must become known, before it can be released/transmuted. -

If you find yourself challenged in any way, I invite you to alchemize and cocreate with me, within the frame of a personal consultation combined with energy healing and life transformational coaching.

Yours,

Stephania

Name

Date of birth

Telephone number

Email address

Would you like to be informed for anything new that comes up?

Medical history

Current medication (if any)

Question 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 conflicts?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?

Question 2 - Aspen

Do you have a feeling 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?

Question 3 - Beech

Are you annoyed by the habits and shortcomings of others?Do you feel yourself being overly critical and intolerant, usually looking for what someone has done wrong and not right?Do the incompetence and foolishness of others irritate you?

Question 4 - Centaury

Do you often neglect your own needs to please others?Is it difficult to say no to those who impose upon your good nature?Do you tend to be easily influenced by those stronger in nature than yourself?

Question 5 - Cerato

Do you constantly second guess your own decisions and judgment?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 and unsure?

Question 6 - Cherry Plum

Are you afraid that 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 that you may hurt yourself or others or become violent and explosive?

Question 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 or experience of others?Do you wish you would not repeat the same patterns again and again?

Question 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?

Question 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?

Question 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?

Question 11 - Elm

Do you feel overwhelmed by your responsibilities?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?

Question 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?

Question 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 believe that nothing can be done to relieve your pain and suffering?

Question 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 end up focusing on your interests or problems?

Question 15 - Holly

Are you suspicious of others, feeling that people have “ulterior motives“?Do you feel great anger towards other people?Are you full of jealousy, mistrust or hate?

Question 16 - Honeysuckle

Do you find yourself living in the past, nostalgic or home sick for “the way it was”?Are you unable to change present circumstances because you are always looking back and never forward?Do you often contemplate past regrets?

Question 17 - Hornbeam

Do you often feel too tired 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?

Question 18 - Impatiens

Do you feel a sense of urgency in everything 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?

Question 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?

Question 20 - Mimulus

Do you have fears of identifiable things, ie illness, death, pain, heights, darkness, the dentist, etc?Are you shy, overly sensitive and often afraid?Do you often worry about everyday situations, in other words traffic, bills etc?

Question 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?

Question 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?

Question 23 - Olive

Do you feel utterly and completely exhausted, 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?

Question 24 - Pine

Do you set overly high standards for yourself, never satisfied 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?

Question 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?

Question 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?

Question 27 - Rock Water

Do you set high personal standards and take pride of setting a good example for others?Are you overly concerned with diet, exercise, work and spiritual disciplines?Are you extremely disciplined with your approach to life, always striving for perfection?

Question 28 - Scleranthus

Do you find it difficult to decide when faced with the choice of two possibilities?Do you lack concentration, always fidgety and nervous?Do your moods change from one extreme to another: joy to happiness, optimism to pessimism, laughing to crying?

Question 29 - Star of Bethlehem

Have you suffered a recent shock in your life such as an accident, loss of a loved one, terrible news, illness?Are you numbed or withdrawn because of traumatic events in your life?Have you suffered a loss or grief from which you have never recovered?

Question 30 - Sweet Chestnut

Do you suffer from extreme mental or emotional anguish?Do you feel that 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?

Question 31 - Vervain

Do you have so much energy and drive, that you are 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 it is extreme?

Question 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?

Question 33 - Walnut

Are you experiencing any change in your life -- a move, new job, loss of someone you love, new relationship, divorce, puberty, menopause, giving up an addiction?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?

Question 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?

Question 35 - White Chestnut

Do you find your head full of persistent, unwanted thoughts that prevent concentration?Do you relive unhappy events or arguments 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?

Question 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 of which way to go?Do you have ambition but feel that life is passing you by?

Question 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?

Question 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?