THE ORIGINAL DR.BACH FLOWER ESSENCES
YOUR PERSONAL QUESTIONAIRE

(Tick any boxes where the statement seems to match the way you feel today)Read through all 38 questions, check only the boxes that pertain to you and at the end we will summarize and customize your personal remedy blend according to your answers, which will be an indication of your present emotional state.In time,your remedy blend will help you to feel more balanced and less stressed. Each Bach remedy bottle will be prepared for you and shipped directly to your address with an explanation of your results and the directions on how to take your BACH homeopathic remedy.(CLICK HERE TO FIND DIRECTIONS ON HOW TO TAKE THE BACH FLOWER REMEDIES)

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Name:
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AGRIMONY:
Do you hide behind a happy face apearance when out in public?
Do you give in to avoid arguments?
When life is to stressful do you turn to a comfort addiction in order to relax?

ASPEN:
Do you have feelings of anxiety without knowing why?
Do you feel uneasy like something bad might happen?
Are you afraid of the unknown future?

BEECH:
Are you critical of people's irritating habits?
Do you see the imperfections in things faster than most?
Do you wish you could change all that annoys you?

CENTAURY:
Do you find it hard to say NO?
Are you afraid of hurting people's feelings?
Do you tend to find yourself over-committed to activities due to peer pressure?

CERATO:
Do you second guess your decisions?
Are you asking others for their opinion all the time?
After getting answers from others, do you find you doubt yourself and make wrong decision?

CHERRY PLUM:
Do you just hold it together by a thread some days?
Do you have it under control until someone pushes the wrong buttons to trigger you?
Are you afraid that you may do some action that you will regret later?

CHESTNUT BUD:
Do you find yourself making the same mistakes in life over and over again?
Do you see a pattern in your attracting negative circumstances into your life?
Do you get mad at yourself for not learning the wisdom in the lesson the first time?

CHICORY:
Do you like being dependable and wanted by family and friends?
Do you feel you know what is best for those you care for?
Do you feel unappreciated or unrespected by those closest to you?

CLEMATIS:
Do you feel mentally tired, forgetful or sleepy most of the day?
Do you find it hard to keep your mind focused on daily errands or details?
Do you escape in your mind and dream up a more exciting life for yourself?

CRAB APPLE:
Do you wish you could change your physical body shape and size?
Do you obsess over cleanliness,germs,or spread of disease?
Are you self-conscious of your bodies physical imperfections, such as: pimples and birthmarks?

ELM:
Are you smart but, try to squeeze too much into your daily schedule?
Does your life feel overwhelming with too much responsiblity and pressure?
Do you become mentally exhausted or depressed thinking about how to tackle the job?

GENTIAN:
Do you become easily discouraged after the first attempt at trying something?
Do you give up early because the problem gets too hard?
Do you become depressed over the situation which prevents you from finishing the job?

GORSE
Do you feel helpless and sad?
Have you lost faith in your in your life and feel stuck?
Do you believe there is nothing more that can be done to help your situation?

HEATHER:
Do you find your friends or family tell you, it is all about you all the time?
Do you feel lonely and lost without your friends around to talk to?
Are you constantly telling people about your day and sharing your life experiences?

HOLLY:
Do you feel anger towards someone, beyond forgiveness?
Are you jealous or suspicious of someone?
Do you find it hard to fully open your heart and trust again?

HONEYSUCKLE:
Do you wish you could relive your past memories one last time?
Do you think of past regrets and wish you could go back in time to change things?
Are you unable to deal with your life today;always thinking about what used to be?

HORNBEAM:
Do you procrastinate your chores but, find energy to party?
Do you feel your work, school, or life is boring?
Do you feel tired just thinking about the normal day ahead of you?

IMPATIENS:
Would you rather work alone on a project than with a team?
Are you irritated with people who work too slow for your expectations?
Would you like to get the job over with and finished ahead of schedule?

LARCH:
Do you lack self-confidence in your skills?
Are you tired of trying because you failed so many times before?
Do you feel you never seem to win at anything?

MIMULUS:
Are you shy,or extremely uncomfortable around people?
Do you worry about money,rush hour traffic,credit card debt?
Do you suffer from any phobias?ex.heights,flying,dentist,dark,water.?

MUSTARD:
Do you wake up feeling depressed but,can't figure out why?
Do you crave more sunlight in your life?
Do your moods swing unpredictably back and forth?

OAK:
Are you exhausted but,feel a duty to complete the job?
Are you dedicated to the end, sometimes struggling against all odds?
Do you neglect your health till the task is complete?

OLIVE:
Have you just been through a long period of illness?
Do you feel completely exhausted both physically and mentally?
Are you drained of your energy reserves,finding it difficult to go on?

PINE:
Do you feel guilty about something?
Do you naturally blame yourself if something goes wrong?
Do you put high demands on yourself, always believing you should do better?

RED CHESTNUT:
Are you often worried about the safety of your loved ones?
Do you take on other peoples' problems and try to fix them?
Does any problem within the family unit distress you?

ROCK ROSE:
Are you prone to feelings of anxiety and panic?
Do you freeze with fear during a high stress situation?
Do you get haunted in your sleep when a problem consumes you?

ROCK WATER:
Do you set high personal standards for yourself?
Are you strict with yourself regarding diet,excercise,work,play,and spirit?
Are you disciplined and determined to achieve perfection on yourself?

SCLERANTHUS:
Can you make up your mind easily when deciding between two choices?
Do you feel scattered, fidgety, with nervous energy?
Do you suffer from motion sickness?

STAR OF BETHLEHEM:
Have you lived through a traumatic experience you can not heal from?
Do you find it difficult to discuss any past trauma that happened to you?
Have you just gone through a major life adjustment involving terrible news?

SWEET CHESTNUT:
Do you feel that you are alone and see no light at the end of the tunnel?
Are you suffering from emotional or mental stress?
Do you feel that you are at the end of your rope and no place to turn?

VERVAIN:
Do you get frustrated when people can't understand your views?
Are you obsessed about a new project that you can not stop thinking about?
Do you try to convince others to help when an injustice has been done that you feel is not fair?

VINE:
Do things work better and smoother when you are in charge?
Do you enjoy being the leader of a group?
Are you motivated and focused to a point, that it is hard for others to work with you?

WALNUT:
Are you attracting people in you life that drain your energy?
Are you going through any kind of life adjustment? ex.(retire,job,marry,divorce,death,move,rehab,puberty,menopause)?
Is it time to break away from people and old patterns that are holding us back?

WATER VIOLET:
Do others see you as a loner?
Are you more comfortable being alone when you are dealing with personal issues?
Are you quite happy being quiet,with no distractions?

WHITE CHESTNUT:
Is your mind always thinking,even at bedtime?
Do you try to play out the scenerio in your head over and over?
Is your brain tired; lacking focus and concentration?

WILD OAT:
Do you feel that you have so much more to offer and life is passing you by?
Are you at a fork in the road and do not know which way to go?
Do you find yourself stuck in a rut over what to do with your life?

WILD ROSE:
Do you catch yourself saying the phrase"whatever happens happens"?
Would you like to change your life? but, doubt it would work out?
Are you always dreaming of a better life but, figure yours is not so bad after all?

WILLOW:
Do you feel life is not fair,like you're getting the short end of the stick?
Has a person done you wrong and you can not forget it?
Is there someone in your life that you need to forgive?

RESCUE REMEDY:
Do you feel anxious when driving in rush hour?
Are you needing some relief from everyday stress?
Do you get nervous before a test, interview, or meeting?

NOW THAT YOU HAVE COMPLETED THE 38 QUESTIONS AND CHECKED ONLY THE BOXES THAT APPLY TO YOU, YOUR DR. BACH REMEDY BOTTLE WILL BE MADE UP AND CUSTOMIZED TO MEET YOUR SPECIFIC EMOTIONAL NEEDS.

Please Note: By filling out this questionaire and submitting your results to Rainbow Power, Maryjane Gottschlag,B.F.R.P. is a qualified Dr. Bach International Registered Practitioner with the Bach Foundation in Mt. Vernon, England. All results will be kept confidential and all custom blends will be mixed from the Original Bach Essences open stock remedies. (All cost will be paid for ahead of delivery and shipping will be added)

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