Helping you regain control of your Health
Cart 0

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                                                                                  Aspen 

I 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
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”

Contact:   New Life Spa Wellness Center
                 Deborah Stauss, ND
                 (918) 948-2758