Bach Flower Questionnaire
Bach Flower Questionnaire
Print page. Put a checkmark next to each statement that applies to you. Choose the top 5 Remedies that you put the most marks by. Call New Life Spa Wellness Center (918) 948-2758 to order your custom Bach Flower Remedy or order online here. To download or print Questionnaire click here.
Agrimony AspenI hide my feelings behind a facade of cheerfulness I feel anxious without knowing why
I dislike arguments and often give in to avoid conflict I have a secret fear that something bad will happen
I turn to food, work, alcohol, drugs, etc. when down I wake up feeling anxious
Beech Centaury
I get annoyed by the habits of others I often neglect my own needs to please
I focus on others’ mistakes I find it difficult to say “no”
I am critical and intolerant I tend to be easily influenced
Cerato Cherry Plum
I constantly second-guess myself I’m afraid I might lose control of myself
I seek advice, mistrusting my own intuition I have sudden fits of rage
I often change my mind out of confusion I feel like I’m going crazy
Chestnut Bud Chicory
I make the same mistakes over and over I need to be needed and want my loved ones close
I don’t learn from my experience I feel unloved and unappreciated by my family
I keep repeating the same patterns I easily feel slighted and hurt
Clematis Crab Apple
I often feel spacey and absent minded I am overly concerned with cleanliness
I find myself unable to concentrate for long I feel unclean or physically unattractive
I get drowsy and sleep more than necessary I tend to obsess over little things
Elm Gentian
I feel overwhelmed by my responsibilities I become discouraged with small setbacks
I don’t cope well under pressure I am easily disheartened when faced with difficulties
I have temporarily lost my self-confidence I am often skeptical and pessimistic
Gorse Heather
I feel hopeless, and can’t see a way out I am obsessed with my own troubles
I lack faith that things could get better in my life I dislike being alone and I like to talk
I feel sullen and depressed I usually bring conversations back to myself
Holly Honeysuckle
I am suspicious of others I’m often homesick for the “way it was”
I feel discontented and unhappy I think more about the past than the present
I am full of jealousy, mistrust, or hate I often think about what might have been
Hornbeam Impatiens
I often feel too tired to face the day ahead I find it hard to wait for things
I feel mentally exhausted I am impatient and irritable
I tend to put things off I prefer to work alone
Larch Mimulus
I lack self-confidence I am afraid of things such as spiders, illness, etc.
I feel inferior and often become discouraged I am shy, overly sensitive, and modest
I never expect anything but failure I get nervous and embarrassed
Mustard Oak
I get depressed without any reason I tend to overwork and keep on in spite of exhaustion
I feel my moods swinging back and forth I have a strong sense of duty and never give up
I get gloomy feelings that come and go I neglect my own needs in order to complete a task
Olive Pine
I feel completely exhausted, physically and/or mentally I feel unworthy and inferior
I am totally drained of all energy with no reserves left I often feel guilty
I have just been through a long period of illness or stress I blame myself for everything that goes wrong
Red Chestnut Rock Rose
I am overly concerned and worried about my loved ones I sometimes feel terror and panic
I am distressed and disturbed by other people’s problems I become helpless and frozen when afraid
I worry that harm may come to those I love I suffer from nightmares
Rock Water Scleranthus
I set high standards for myself I find it difficult to make decisions
I am strict with my health, work &/or spiritual discipline I often change my opinions
I am very self-disciplined, always striving for perfection I have intense mood swings
Star of Bethlehem Sweet Chestnut
I feel devastated due to a recent shock I feel extreme mental or emotional heartache
I am withdrawn due to traumatic events in my life I have reached the limits of my endurance
I have never recovered from loss or fright I am in complete despair, all hope gone
Vervain Vine
I get high-strung and very intense I tend to take charge of projects, situations, etc.
I try to convince others of my way of thinking I consider myself a natural leader
I am sensitive to injustice, almost fanatical I am strong-willed, ambitious and often bossy
Walnut Water Violet
I am experiencing change in my life–a move, new job, etc. I give the impression that I’m aloof
I get drained by people or situations I prefer to be alone when overwhelmed
I want to be free to follow my own ambitions I often don’t connect with people
White Chestnut Wild Oat
I am constantly thinking unwanted thoughts I can’t find my path in life
I relive unhappy events or arguments over and over again I am drifting in life and lack direction
I am unable to sleep at times because I can’t stop thinking I am ambitious but don’t know what to do
Wild Rose Willow
I am apathetic and resigned to whatever happens I feel resentful and bitter
I have the attitude, “It doesn’t matter anyhow” I have difficulty forgiving and forgetting
I feel no joy in life I think life is unfair and have a “Poor me attitude”
Deborah Stauss, ND
(918) 948-2758