Bach Flower Essence Questionnaire

The gentle power of Bach essences promotes healing through levels of the subtle energetic, emotional body. Such healing can point the way to further steps in an individual’s process of growth. With a positive mental attitude and sense of balance, overall wellness is achieved. Bach essences are safely used with all other healing modalities. Read further about Bach Flower Essences: tinyurl.com/y98ov6ur

1) AGRIMONY
Do you hide your worries behind a cheerful, smiling face to conceal your pain?
Are you distressed by arguments and quarrels often giving in to avoid conflict?
When pressures weigh on you, do you often turn to food, work, alcohol, drugs or other outside influences to help you cope?

2) ASPEN
Do you feel apprehension or anxiety without knowing why?
Do you fear something bad may happen but not sure why?
Do you wake with a sense of anxiety about what the day will bring?

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

4) CENTAURY
Do you regularly neglect your own needs in order to please others?
Is it difficult to say no to those who impose on your good nature?
Do you tend to be easily influenced by those stronger in nature than yourself?

5) CERATO
Do you constantly second-guess your own decisions and judgment?
Do you often seek advice and confirmation from others, mistrusting your own intuitions?
Do you change direction often, even after asking advice, feeling unsure or confused?

6) CHERRY PLUM
Are you afraid you might lose control physically, mentally or emotionally?
Do you fear you may think or do something that is wrong?
Do you feel like hurting yourself or others, possibly becoming explosive or violent?

7) CHESTNUT BUD
Do you seem to make the same mistakes regardless of ultimately knowing better?
Do you wish you wouldn’t repeat the same patterns over and over?
Do you neglect to learn from the mistakes of others even when they directly apply to your situation?

8) CHICORY
Do you need to be needed and want your loved ones close at hand?
Do you feel unloved / unappreciated by those close to you?
Are you possessive of those you care for, feeling you know what is best for them?

9) CLEMATIS
Are you often spacey and absent-minded?
Are you preoccupied, unable to concentrate for any length of time; dreamy?
Are you drowsy and listless, sleeping more than necessary?

10) CRAB APPLE
Are you obsessed with cleanliness, or overly concerned with toxicity and contamination?
Are you embarrassed or ashamed of yourself, or feel physically unattractive?
Do you tend to concentrate on small physical imperfections such as blemishes or marks?

11) ELM
Do you feel overwhelmed by your responsibilities?
Do you feel overwhelmed by the many tasks ahead of you?
Do you become exhausted or depressed faced with your daily commitments?

12) GENTIAN
Are you easily depressed or discouraged when things go wrong?
Are you easily disheartened when faced with difficult situation?
Do you allow your depressed attitude to prevent you from accomplishing something?

13) GORSE
Do you feel hopeless, as if there is no reason to try?
Do you lack faith that your circumstances will improve and therefore make no effort?
Do you believe that nothing is likely to relieve your pain and suffering?

14) HEATHER
Do others avoid you because you talk too much?
Do you dislike being alone, seeking others to have someone to talk to?
Do your conversations usually come back to your problems or interests?

15) HOLLY
Are you suspicious of others, feeling others having “ulterior motives”?
Do you have great anger toward other people and situations?
Are you prone to feeling hate, mistrust or jealousy?

16) HONEYSUCKLE
Do you live in shades of the past; homesick for the way it was, nostalgic?
Are you always looking back which prevents moving forward?
Do you often contemplate past regrets?

17) HORNBEAM
Do you often feel too tired to face the day ahead?
Do you feel overworked or bored with your life?
Do you routinely procrastinate on difficult or tedious tasks?

18) IMPATIENS
Do you feel a sense of urgency, always rushing to get through everything you do?
Are you impatient and irritable with people who do things at a slower pace than you?
Do you prefer to work alone?

19) LARCH
Do you lack self-confidence?
Do you feel inferior and often becoming discouraged?
Are you so sure you will fail that you do not even try?

20) MIMULUS
Do you have fears of identifiable things, i.e. illness, death, pain, heights, darkness, the dentist?
Are you shy, overly sensitive and often afraid?
Do you often worry about everyday situations, i.e. traffic, bills, etc.?

21) MUSTARD
Do you feel depressed without knowing why?
Do you experience significant mood swings?
Do you experience deep gloom, which descends and lifts for no apparent reason?

22) OAK
Are you exhausted but struggle onward despite odds?
Do you have a strong sense of duty and dependability no matter what obstacles you face?
Do you neglect your own needs in order to complete a task?

23) OLIVE
Are you utterly and completely exhausted, both physically and mentally?
Are you totally drained with no reserves, finding it difficult to carry on?
Have you recently been through a long period of illness, stress or strain without relief?

24) PINE
Do you set overly high standards for yourself, never satisfied with your achievements?
Do you feel guilt and self-reproach?
Do you blame yourself for everything that goes wrong, sometimes event the mistakes of others?

25) RED CHESTNUT
Are you often quite concerned and worried about your loved ones?
Are you distressed or disturbed by other people’s problems?
Do you worry that harm may befall to those you care for?

26) ROCK ROSE
Are you susceptible to feelings of panic or terror?
Do you become helpless and frozen in the face of your fear?
Do you suffer from nightmares?

27) ROCK WATER
Do you set high personal standards and take pride in setting a good example for others?
Are you greatly concerned with diet, exercise, spiritual disciplines, and work?
Are your ways extremely disciplined, always striving for perfection?

28) SCLERANTHUS
Do you find it difficult to choose between possibilities?
Do you lack concentration, nervously fidgeting?
Do your moods shift from one extreme to another; laughing to crying, optimism to pessimism, etc.?

29) STAR OF BETHLEHEM
Have you suffered a recent shock in life such as an accident, loss of loved one, illness, terrible news?
Are you numbed of withdrawn due to traumatic events in your life?
Have you suffered grief, loss or trauma from which you have never recovered?

30) SWEET CHESTNUT
Do you suffer from extreme mental or emotional anguish?
Are you at the limits of your endurance?
Do you feel there is no light at the end of the tunnel?

31) VERVAIN
Do you have so much drive and energy that you are tense and unable to sleep?
Do you have strong opinions and try to convince others of them?
Are you sensitive to injustice and dedicated to causes almost to extremes?

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 and may appear aggressive and domineering to others?

33) WALNUT
Are you experiencing any change in your life-a move, new job, new relationship, divorce, puberty, menopause, divorce, addiction cessation, etc.?
Do people or situations often drain your energy?
Do you need to make a break from strong forces or attachments in your life that are holding you back?

34) WATER VIOLET
Do you appear to others to be aloof or overly proud? And prefer to be alone when faced with too many external distractions?
Are you withdrawn?
Do you bear your grief and sorrow without talking to others?

35) WHITE CHESTNUT
Is your head full of persistent worries, unwanted thoughts that take you out of the moment?
Do you revive unhappy events or arguments again and again?
Are you unable to sleep at times because your mind is cluttered with mental arguments and spinning thoughts?

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

37) WILD ROSE
Are you apathetic and resigned to whatever happens in your life?
Do you have an, “It doesn’t matter anyhow” attitude?
Do you lack motivation to improve the quality of your life?

38) WILLOW
Do you feel resentful, bitter?
Do you have difficulty forgiving and forgetting?
Do you feel certain situations/life unfair, eroding your pleasure and interest in life.

Return this questionnaire at your next visit

for your personalized Bach Essence formula.

How to take Bach Flower Essences:
-Add 2 drops of your chosen remedy to any beverage and sip at intervals.
-When combining remedies, fill a 2 oz tincture bottle with 2 drops of each remedy, and take 4 drops under the tongue at least 4 times daily.
-Bach remedies may also be taken by placing 2 drops under the tongue directly; or by rubbing onto the lips, behind the ears, on the temples, or wrists.

 

 
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