Bach Flower Remedy Chooser

Name

Phone

Fears (check all that apply, but remember - choose only 7 total for whole questionnaire) Fears (check all that apply, but remember - choose only 7 total for whole questionnaire) Have experienced terror, been frozen in fear Fear rooted in known causes, ex. flying etc. Fear losing control of your behavior Unexplained fears/worries, are nervous/anxious Over-anxious or over-concerned for others

Sensitivity (check all that apply, but remember - choose only 7 total for whole questionnaire) Sensitivity (check all that apply, but remember - choose only 7 total for whole questionnaire) Put on a cheerful face to hide problems Difficulty in saying no, anxious to please Face major life changes Feelings of extreme jealousy, envy, suspicion Need protection against people's negative influence

Decisiveness (check all that apply, but remember - choose only 7 total for whole questionnaire) Decisiveness (check all that apply, but remember - choose only 7 total for whole questionnaire) Doubt your own ability to judge situations Suffer from indecision, can't choose b/w 2 things Easily discouraged after a setback and despondent "Monday" morning feeling, too tired to face the day Uncertainty over ones' direction in life Drifting, resignation, apathy

Concern for Others (check all that apply, but remember - choose only 7 total for whole questionnaire) Concern for Others (check all that apply, but remember - choose only 7 total for whole questionnaire) Dominant, natural leader and strong willed Overenthusiastic, argumentative Critical & intolerant of others Self-denial, rigidity and self-repression Possessive of loved ones, need to be needed

Attention (check all that apply, but remember - choose only 7 total for whole questionnaire) Attention (check all that apply, but remember - choose only 7 total for whole questionnaire) Day-dream, generally lack interest in the present Live in the past, feel nostalgic/homesick Exhaustion following physical/mental effort Unwanted thoughts, worries, preoccupations Experience unexplained gloom Fail to learn from past experience, repeating mistakes

Loneliness (check all that apply, but remember - choose only 7 total for whole questionnaire) Loneliness (check all that apply, but remember - choose only 7 total for whole questionnaire) Prefer to be alone or are proud/aloof Impatient & easily irritated Self-absorbent-talkative, dislike being alone

Mental Attitude (check all that apply, but remember - choose only 7 total for whole questionnaire) Mental Attitude (check all that apply, but remember - choose only 7 total for whole questionnaire) Lack self-confidence, feel inferior Feel full of guilt, blame yourself Overwhelmed or burdened by responsibility Mental anguish, no light at the end of the tunnel Have experienced shock, grief, or fright Resentful & feelings of self-pity, "poor me" Driven by a strong sense of duty Have a poor self-image, ashamed physically Keeps going past the point of exhaustion Hopeless, feeling nothing can be done, despair Setting overly high standards for yourself