Bach Flower Questionnaire - BachFlower.com

The Original Bach Flower Remedies is a natural system of healing.

Dr. Edward Bach discovered that flowers in nature have the ability to affect our emotions positively. The energies from certain flowers can remove our emotional pains and suffering, which over time harm our health and impair healing.

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Date

MonthDayYear

Name

First NameLast Name

Email (Results to this email address)

example@example.com

INSTRUCTIONS

1. Read each statement and check each that describes how you feel right now. Submit

2. You will receive an email with further instructions.

AGRIMONY

I often hide my feelings behind a facade of cheerfulnessI dislike arguments and often give in to avoid conflictI turn to food, work, alcohol, drugs, etc. when down

ASPEN

I feel anxious without knowing whyI have a strange fear that something bad will happenI wake up feeling anxious

BEECH

I easily get annoyed by the habits of othersI often focus on others peoples mistakesI find myself being critical and intolerant of others

CENTAURY

I often neglect my own needs to please othersI find it difficult to say "no"I tend to be easily influenced

CERATO

I constantly second-guess myselfI seek advice, mistrusting my own intuitionI often change my mind out of confusion

CHERRY PLUM

I'm afraid I might lose control of myselfI have sudden fits of rageI feel like I'm going crazy

CHESTNUT BUD

I make the same mistakes over and overI don't learn from my experienceI keep repeating the same wrong patterns

CHICORY

I need to be needed and want my loved ones closeI feel unloved and unappreciated by my familyI easily feel slighted and hurt

CLEMATIS

I often feel spacey and absent mindedI find myself unable to concentrate for longI get drowsy and sleep more than necessary

CRAB APPLE

I am overly concerned with cleanlinessI feel unclean or physically unattractiveI tend to obsess over little things

ELM

I feel overwhelmed by my responsibilitiesI don't cope well under pressureI have temporarily lost my self-confidence

GENTIAN

I become discouraged with small setbacksI am easily disheartened when faced with difficultiesI am often skeptical and pessimistic

GORSE

I feel hopeless, and can't see a way outI lack faith that things could get better in my lifeI feel sullen and depressed

HEATHER

I am obsessed with my own troublesI dislike being alone and I like to talkI usually bring conversations back to myself

HOLLY

I am suspicious of othersI feel discontented and unhappyI am full of jealousy, mistrust, or hate

HONEYSUCKLE

I'm often homesick for the "way it was"I think more about the past than the presentI often think about what might have been

HORNBEAM

I often feel too tired to face the day aheadI feel mentally exhaustedI tend to put things off and may procrastinate

IMPATIENS

I find it hard to wait for thingsI am impatient and irritableI prefer to work alone

LARCH

I lack self-confidenceI feel inferior and often become discouragedI never expect anything but failure

MIMULUS

I am afraid of things such as spiders, illness, etc.I am shy, overly sensitive, and modestI often get nervous and embarrassed

MUSTARD

I get depressed without any reasonI feel my moods swinging back and forthI get gloomy feelings that come and go

OAK

I tend to overwork and keep on in spite of exhaustionI have a strong sense of duty and never give upI neglect my own needs in order to complete a task

OLIVE

I feel completely exhausted, physically and/ or mentallyI am totally drained of all energy with no reserves leftI have just been through a long period of illness or stress

PINE

I feel unworthy and inferiorI often feel guiltyI blame myself for everything that goes wrong

RED CHESTNUT

I am overly concerned and worried about my loved onesI am distressed and disturbed by other people's problemsI worry that harm may come to those I love

ROCK ROSE

I sometimes feel terror and panicI become helpless and frozen when afraidI suffer from nightmares

ROCK WATER

I set high standards for myselfI am strict with my health, work &/or spiritual disciplineI am very self-disciplined, always striving for perfection

SCLERANTHUS

I find it difficult to make decisions when I have 2 optionsI often change my opinionsI have intense mood swings

STAR OF BETHLEHEM

I feel devastated due to a recent shockI am withdrawn due to traumatic events in my lifeI have never recovered from loss, trauma or fright

SWEET CHESTNUT

I feel extreme mental or emotional heartacheI have reached the limits of my enduranceI feel complete despair, all hope gone

VERVAIN

I get high-strung and very intenseI try to convince others of my way of thinkingI am sensitive to injustice, almost fanatical

VINE

I tend to take charge of projects, situations, etc.I consider myself a natural leaderI am strong-willed, ambitious and often bossy

WALNUT

I am experiencing change in my life; a move, new job, etc.I get drained by people or situationsI want to be free to follow my own ambitions

WATER VIOLET

I give the impression that I'm aloofI prefer to be alone when overwhelmedI often don't connect with people

WHITE CHESTNUT

I have repeated unwanted thoughts and worriesI relive unhappy events or arguments over and over againI am unable to sleep at times because I can't stop thinking

WILD OAT

I can't find my path in lifeI am drifting in life and lack directionI am ambitious, but don't know what to do

WILD ROSE

I am apathetic and resigned to whatever happensI have the attitude, "It doesn't matter anyhow"I feel no joy in life

WILLOW

I feel resentful and bitterI have difficulty forgiving and forgettingI think life is unfair and have a "Poor me attitude"

RESCUE REMEDY

How was your experience with the questionnaire?

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The result of the Questionnaire will arrive shortly by email.

This form serves only as a suggestion. Learn more about the remedies before you take them at www.BachFlower.com, and follow the instructions that will arrive in the email with your questionnaire result.

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