FINDHORN FLOWER ESSENCES

PERSONAL ASSESSMENT

The Client Background Questionnaire is offered as a service to provide you with flower essences individually formulated for you: your individual issues and purposes.

The assessment fee is UK £50 Sterling which includes the cost of one 15ml bottle of Stock flower essence or combination and postage and packing. Detailed instructions for taking the remedy will be sent.

Please fill in the questionnaire and then click the 'submit' button. You will then be taken to a page where you can continue to make your payment via credit card using our secure on-line payment facility.

Please note: we cannot do your assessment until we receive your payment. An e-mail will be sent to you informing you that we have carried out your assessment and that your remedy has been despatched.

We treat the information that you send us as confidential . We will not pass your details to anyone else.
Name:
Address:
District / Town:
Country:

Telephone:
Email:
Date of Birth:
Place of Birth:
Have you used flower essences before? YesNo
Please give a brief summary of your experiences:
What are your reasons for wanting to use flower essences now?
With whom do you live?
What kind of work do you do?
How do you relax? List hobbies.
What is your favourite colour?
Do you crave any particular food or drink?
What time of day do you have the most and the least energy?
How do you respond to stress?
Have you experienced any major emotional trauma or stress in your life - eg. (eg death of a loved one, divorce, money problems, job change, chronic illness)? YesNo
In the past year? YesNo
In the past 5 years? YesNo
List three negative words that describe you.
List three positive words that describe you.
Give a brief description of your general state of health:
physical:
emotional:
mental:
spiritual: