Bach Flower Questionnaire

Bach store India · www.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.

Order at www.bachstoreindia.com · More info: www.BachFlower.com

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Last Name

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INSTRUCTIONS

Check every statement that describes how you feel right now.
Click Submit — review your selections then send to store.
The store receives your selections by email and will follow up.

AGRIMONY

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

ASPEN

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

BEECH

I easily get annoyed by the habits of others I often focus on other people's mistakes I find myself being critical and intolerant of others

CENTAURY

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

CERATO

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

CHERRY PLUM

I'm afraid I might lose control of myself I have sudden fits of rage I feel like I'm going crazy

CHESTNUT BUD

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

CHICORY

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

CLEMATIS

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

CRAB APPLE

I am overly concerned with cleanliness I feel unclean or physically unattractive I tend to obsess over little things

ELM

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

GENTIAN

I become discouraged with small setbacks I am easily disheartened when faced with difficulties I am often skeptical and pessimistic

GORSE

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

HEATHER

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

HOLLY

I am suspicious of others I feel discontented and unhappy I 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 present I often think about what might have been

HORNBEAM

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

IMPATIENS

I find it hard to wait for things I am impatient and irritable I prefer to work alone

LARCH

I lack self-confidence I feel inferior and often become discouraged I never expect anything but failure

MIMULUS

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

MUSTARD

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

OAK

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

OLIVE

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

PINE

I feel unworthy and inferior I often feel guilty I blame myself for everything that goes wrong

RED CHESTNUT

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

ROCK ROSE

I sometimes feel terror and panic I become helpless and frozen when afraid I suffer from nightmares

ROCK WATER

I set high standards for myself I am strict with my health, work and/or spiritual discipline I am very self-disciplined, always striving for perfection

SCLERANTHUS

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

STAR OF BETHLEHEM

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

SWEET CHESTNUT

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

VERVAIN

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

VINE

I tend to take charge of projects, situations, etc. I consider myself a natural leader I 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 situations I want to be free to follow my own ambitions

WATER VIOLET

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

WHITE CHESTNUT

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

WILD OAT

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

WILD ROSE

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

WILLOW

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

RESCUE REMEDY

Created by Dr. Bach for emergencies and crises — take as often as needed.

I have experienced a trauma I feel very stressed out I feel irritated and impatient I feel un-grounded and spacey I feel frightened and frozen I feel I may lose self-control

This form serves as a suggestion only. Please read about the remedies before taking them.

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One last step

Please complete the verification below, then click Send to Store & View Results.

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Bach Flower Questionnaire

Bach store India · www.BachFlower.com

✓

Congratulations — Your Results Are Ready!

📧 ✓ Email notification sent to Bach Store India — we will reply to your email with personalised guidance.

Select the remedies most important for you — blend a maximum of 7 remedies per treatment bottle.

Your Indicated Remedies

How to Make Your Treatment Bottle

Add 2 drops of each selected remedy to a 30 ml / 1 oz mixing bottle.
Combine up to 6–7 remedies in one bottle.
Optional: add 1 teaspoon of brandy, apple cider vinegar, or vegetable glycerin.
Fill to the top with still water.
Take 4 drops, 4 times a day until you feel better.

Rescue Remedy: 4 drops directly in mouth or 2–4 drops in water, as often as needed.

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Our staff is trained by the Bach Centre in England.

This form serves as a suggestion only. Please read about the Bach Flower Remedies before taking them.

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Bach Flower Questionnaire

Bach Flower Questionnaire

How to Make Your Treatment Bottle

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Bach Flower Questionnaire

Bach Flower Questionnaire

How to Make Your Treatment Bottle

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