Bach Flower Remedy Questionnaire

HEALTH INFORMATION SERIES  
The Bach Flower Remedies are a very subtle way of using plants to heal emotional aspects of a person. They are gentle, effective and completely without harmful side-effects. The following questionnaire has been devised in order to help us to determine the most effective remedies for you at this present time. 

Underneath each name write a number from 0 to 10 according to how strongly you identify with the emotions ascribed to each category. A zero (0) means that you do not experience this emotion while a ten (10) means that you strongly experience this emotion.  To determine your remedies take the 3 - 5 highest scoring remedies and use 4 drops of each in a clean glass dropper bottle.  Top up with 50% brandy and 50% pure spring water.  Take 4 drops four times daily.
 

AGRIMONY: 
Do you 'suffer in silence', holding in your fears and worries and hiding them behind a brave face? 
Do you dislike being alone and seek companionship in order to forget your worries? 
Do you use drugs or alcohol to dull your fears and anxieties? 

ASPEN: 
Do you have vague or formless fears? 
Do you have fears of unknown origin or a sense of impending dread?

BEECH: 
Are you critical and intolerant, or lacking in patience and understanding?
Do you crave order and discipline in yourself and others?

CENTAURY: 
Are you timid and easily imposed upon?
Do you have a hard time saying no, and find yourself doing things for others that you don't really want to?
Are you easily influenced by other people?

CERATO: 
Do you doubt your own abilities, judgements or beliefs?
Do you have a hard time making decisions and seek the advice of others before making commitments? 
Do you tend to imitate others?

CHERRY PLUM: 
Do you have a fear of losing control or of breaking down?
Do you feel desperate or suicidal?
Do you have sudden violent impulses toward yourself or others?

CHESTNUT BUD: 
Do you tend to repeat mistakes and to fail to learn from experience?

CHICORY: 
Are you possessive or interfering in the lives of others?
Do you easily feel hurt, rejected or offended?
Are you irritable or demanding?

CLEMATIS: 
Are you dreamy and inattentive, lost in your thoughts?
Are you absent-minded, impractical or pre-occupied?
Are you with-drawn, preferring your own company?
Do you fall asleep in the day or frequently feel drowsy or listless?

CRAB APPLE:
Do you feel physically or mentally unclean or disgusted with yourself?
Do you feel you have said or done something contrary to your true nature?
Are you excessively fussy and house proud?

ELM: 
Do you feel overwhelmed by responsibilities or the demands made on you?
Do you feel exhausted and unequal to the task required of you?

GENTIAN: 
Do you feel despondent, melancholic or depressed?
Are you easily discouraged?

GORSE: 
Do you feel hopeless and despairing?
Do you feel like 'giving up'?

HEATHER: 
Are you self-centered and full of self-concern?
Do you dislike being alone but when with people spend the whole time telling them your problems?
Do you tend to exaggerate your problems (make mountains out of molehills)?

HOLLY: 
Are you jealous, suspicious or filled with hatred for others?
Are you bad tempered and aggressive?

HONEYSUCKLE: 
Are you nostalgic or regretful of the past?
Are you homesick or unable to shut off memories?

HORNBEAM:
Do you feel mentally or physically weary?
Do you doubt your ability to recover or cope?

IMPATIENS: 
Are you irritable, impatient or full of nervous energy?
Do you feel that others do things too slowly?
Are you accident prone through haste?

LARCH: 
Do you feel inferior or lack self confidence?
Are you convinced you will fail before you even try?

MIMULUS: 
Do you suffer from fear of known cause?

MUSTARD: 
Do you feel a despair or depression for no apparent reason?
Do you feel a 'dark cloud' of gloom descending without cause?

OAK: 
Are you tired or despondent but stubbornly persevering?
Do you have trouble asking for help from others?

OLIVE: 
Do you feel a total fatigue of mind and body after some long ordeal?
Do you feel 'burnt out' with no reserve strength?
Do you find it hard to be interested in things that used to give you pleasure?

PINE:
Do you feel guilt and self-reproach?
Do you blame yourself for the mistakes of others?
Are you over-conscientious but rarely satisfied with you achievements?

RED CHESTNUT: 
Are you excessively concerned for other people?

ROCK ROSE: 
Do you feel terror or panic?
Do you have nightmares or panic attacks?

ROCK WATER: 
Do you have strong opinions or ideals that are hard to live up to?
Do you practice rigid self-denial or self-domination?

SCLERANTHUS: 
Do you suffer from indecision or uncertainty?
Are you frequently pulled between two possibilities, causing you to continually change your mind?
Do you swing between extremes of emotion such as joy and sadness, energy and apathy or optimism and pessimism?
Do you suffer from travel sickness?

STAR OF BETHLEHEM:
Are you suffering from shock due to bad news or a sudden fright?

SWEET CHESTNUT: 
Are you suffering from extreme anguish or mental torture?
Have you reached the limit of your endurance?

VERVAIN:
Are you highly strung or a perfectionist?
Do you tend to take on too many jobs at the same time?
Do you feel tense and unable to relax?

VINE: 
Do you crave or exert power and authority?
Do you like to be the leader and expect obedience from others?
Are you inflexible and lacking in compassion?

WALNUT: 
Are you going through a significant transition or change in your life?
Are you making big decisions and feeling an over-influence from others?

WATER VIOLET: 
Are you proud, aloof or condescending?
Do you resent any interference in your affairs by others?

WHITE CHESTNUT: 
Do you experience persisted thoughts that you cannot switch off?
Do you feel pre-occupied and lack concentration?

WILD OAT: 
Are you dissatisfied with your current situation but unable to decide how to change it?
Are you talented and ambitious but at the same time frustrated and depressed?

WILD ROSE: 
Do you feel resigned or apathetic?
Are you weary and lacking in vitality?

WILLOW: 
Do you feel hurt, bitter or resentful?
Are you irritable, sulky or a 'grumbler'?
Do you begrudge the good fortune, health or happiness of others?