Bach flowers diagnosis and treatment form

full name

Age of the patient

Cell phone

Please rate from 1 to 10 how much you agree with what was said. The sentence can refer to you as having

1 - I don't agree at all, I really don't / 10 - I definitely agree, that's how I feel at the moment

2. (ASPEN) I feel that I live in a cloud of fears from an unknown source (t/m)

1. (AGRIMONY) I usually make those around me laugh, but behind the mask hides a tormented figure (T)

4. (CENTAURY) It's hard for me to say no to people, my will is often not considered (T)

3. (BEECH) It's hard for me to accept the different, I criticize the different and the other (T)

6. (CHERRY PLUM) I have a fear of losing control (t/m)

5. (CERATO) I have trouble hearing and following my inner voice, I don't trust my intuition (T)

8. (CHICORY) I give of myself and expect love to be returned accordingly (9)

7. (CHESTNUT BUD) I tend to repeat mistakes I made (t/m)

10. (CRAB APPLE) I feel that I need purification in body and mind (t/m)

9. (CLEMATIS) I feel that I am floating and unstable on the ground (T)

12. (GENTIAN) I am a pessimistic person who often sees the glass as half empty, at this time I see darkness (t/m)

11. (ELM) It seems to me that these are my weak moments, usually I am much stronger (than)

14. (HEATHER) I feel that I need a lot of attention, I'm afraid of loneliness and therefore need it all the time People and attention around me (i)

13. (GORSE) I feel that I have tried everything and it is not working for me, I am discouraged and even desperate (T/M)

16. (HONEYSUCKLE) I remember a lot of my past and it's hard for me to let it go, I relive the past moments over and over again (T)

15. (HOLLY) I have a lot of anger and I get angry a lot, sometimes extremely (T)

18. (IMPATIENS) I lack patience and tolerance (I)

17. (HORNBEAM) I doubt myself and my abilities, I lack motivation (t/m)

20. (MIMULUS) I am afraid and anxious, my fear and anxiety are from a known source (T/M)

19. (LARCH) I lack self-confidence and do not believe in my abilities (T/M)

22. (OAK) I feel that I am overloaded, the warrior in me is finished and I continue to fight anyway (T)

21. (MUSTARD) I am accompanied by black clouds of sadness, I am depressed (t/m

24. (PINE) I am full of guilt, I blame myself, I am always to blame for everything (T)

23. (OLIVE) I am exhausted, my energy is gone or very weak right now (M)

26. (ROCK ROSE) I'm getting into panic situations, I'm panicking (m)

25. (RED CHESTNUT) I endlessly worry about others around me, even in the form of excessive worry (T)

28. (SCLERANTHUS) I'm undecided between two extremes, it's hard for me to make decisions (T/M)

27. (ROCK WATER) I am strict with myself and demand a lot from myself (T)

30. (SWEET CHESTNUT) I'm in total despair (t/m)

29. (STAR OF BETHLEHEM) In the past I experienced trauma, I feel that it still affects me (m)

32. (VINE) I must be in control of every situation, I must hold everything in my hands (T)

31. (VERVAIN) I am constantly in the energy of enthusiasm and incessant movement, I do not relax for a moment (T)

34. (WATER VIOLET) I prefer to be alone, isolate myself and be different, this is who I am (T)

33. (WALNUT) I am currently dealing with changes in my life, I am sensitive, receptive and influenced by my environment (T/M)

36. (WILD OAT) I feel a lack of focus in my life, the purpose of my life is not clear to me (t/m)

35. (WHITE CHESTNUT) I have a lot of disturbing thoughts, I usually talk to myself (m)

38. (WILLOW) I grumble and complain, it's very difficult for me and the environment doesn't help me at all (T)

37. (WILD ROSE) I feel like someone living dead, I am apathetic and submissive (m

Description of the situation / background to the treatment: (please describe in as much detail as possible)