His Holiness
Maharishi
Mahesh Yogi
 
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Heartburn

Your answers will enable us to develop your personalized consultation.
Select the consultation type for this disorder. For more information, click on the consultation type.
   Enhanced ($900)

   Additional or Follow-up ($450)
Issues
1) (required) Check one or more characteristics or information relevant to your current case of Heartburn and its symptoms.
 Gastric reflux  Gastroesophageal reflux disorder (GERD)
 Gastric ulcer  Burning in stomach
 Hiatal hernia  Nausea
 Vomiting  Stomach sensitivity
 Discomfort after eating  Discomfort when stomach is empty
 Inability to tolerate citrus fruit and other acidic foods  Lack of appetite
 Belching  Bloating
 Indigestion  Acid reflux
 Hiccups  Aggravated by stress
 Aggravated by medicines  Blocked energy flow
 Food allergies  None
2) (required) Check one or more primary areas to be addressed.
  Stomach
  Esophagus
  Chest area
3) (required) Check one or more Sensations that are predominant in your case of Heartburn.
  Shakiness   Itching   Numbness   Heaviness   Weakness   Rawness
  Pain   Stiffness, rigidity and/or tightness   Burning   Heat   None caused by HeartburnNone
4) Check one or more kinds of Pain that you experience in association with your case of Heartburn or its symptoms.
  Sharp   Dull/Achey   Burning   Prickling   Stabbing   Shooting
  Unbearable   Constant   Occasional   Intermittent   Acute   Extreme
Current condition
5) (required) Select how often you experience Heartburn or its symptoms.
Frequency of Heartburn
6) (required) Currently, how severe is your case of Heartburn or its associated symptoms?
Duration of Heartburn     mild     moderate     severe     very severe
7) (required) How disabling is your case Heartburn or its symptoms?
Disablity from Heartburn  mildly  moderately  severely  very severely  Not at all
Disorder History
8) (required) Approximately, how long have you had Heartburn or its symptoms?
Duration of Heartburn  years  months  weeks
9) (required) Is your case of Heartburn the result of an accident or another sudden traumatic event?
Heartburn from accident yes  no  unsure
10) (required) Has your case of Heartburn been medically diagnosed?
Heartburn was medically diagnosed yes  no
11) Brief history of your case of Heartburn and its treatment  (optional - up to 250 characters only) 
History of Heartburn
12) How many prior 3-session Maharishi Vedic Vibration Technology consultations have you had for Heartburn?
Prior MVVT treatments for Heartburn  0  1  2  3  4 or more
12) What was the average percentage of relief you gained as a result?
Percent improvemnt through Heartburn  75-100%  50-75%  25-50%  0-25%  Unsure
Comments
13) Additional comments (up to 250 characters only)
Comments about Heartburn

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