Bach Flower Questionnaire
Instructions

1. Read each statement and check the ones that reflect your emotional state at this time.
2. Choose a max of  7 remedies.
3. If you have selected more than 7 remedies, think about your current situation and what you want to improve now, this will help you narrow down your previous selection.
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First and Last Name *
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Agrimony
Aspen
Beech
Centaury
Cerato
Cherry Plum
Chestnut Bud
Chicory
Clematis
Crab Apple
Elm
Gentian
Gorse
Heather
Holly
Honeysuckle
Hornbeam
Impatiens
Larch
Mimulus
Mustard
Oak
Olive
Pine
Red Chestnut
Rock Rose
Rock Water
Scleranthus
Star of Bethlehem
Sweet Chestnut
Vervain
Vine
Walnut
Water Violet
White Chestnut
Wild Oat
Wild Rose
Willow
(Optional) If you want, you can  describe briefly how you feel now or what situation you want to improve at the moment
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