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His Holiness
Maharishi
Mahesh Yogi
Immunological
Main Category Index
Alphabetic Index
Chemical sensitivity
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 Chemical sensitivity and its symptoms.
Itching eyes
Tearing eyes
Red or swollen eyes
Congestion in the nose and sinuses
Runny nose
Rhinitis
Sneezing
Congestion in the lungs
Constricted breathing
Sore throat
Itching skin
Fatigue
Headaches
Brain fog
Disorientation
Backpain
Nausea
Skin reactions
Reaction to airborne pollutants
Reaction to smoke
Reaction to dust mites
Environmental allergies
Triggered by minute amounts of chemicals such as cleaning agents, waxes or paints
Reaction to pesticides
Asthma
Dermatitis
Faintness
Dizziness
Anaphylactic shock
Compromised liver
Irritable bowel syndrome
Digestive problems
Aggravated by stress or anger
Blocked energy flow
None
2)
(required)
Check one or more
primary areas
to be addressed.
Eyes
Nose
Head
Skin
Whole body
3)
(required)
Check one or more
Sensations
that are predominant in your case of Chemical sensitivity.
Shakiness
Itching
Numbness
Heaviness
Weakness
Rawness
Pain
Stiffness, rigidity and/or tightness
Burning
Heat
None
4)
Check one or more kinds of
Pain
that you experience in association with your case of Chemical sensitivity 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 Chemical sensitivity or its symptoms.
Daily
Weekly
Monthly
Yearly
Continuously
Varies
Depends entirely on circumstances
6)
(required)
Currently,
how severe
is your case of Chemical sensitivity or its associated symptoms?
mild
moderate
severe
very severe
7)
(required)
How
disabling
is your case Chemical sensitivity or its symptoms?
mildly
moderately
severely
very severely
Not at all
Disorder History
8)
(required)
Approximately,
how long
have you had Chemical sensitivity or its symptoms?
1
2
3
4
5
6
7
8
9
10-15
16-20
21-30
31 or more
years
months
weeks
9)
(required)
Is your case of Chemical sensitivity the
result of an accident
or another sudden traumatic event?
yes
no
unsure
10)
(required)
Has your case of Chemical sensitivity been
medically diagnosed?
yes
no
11)
Brief history of your case of Chemical sensitivity and its treatment (optional - up to 250 characters only)
12)
How many prior 3-session Maharishi Vedic Vibration Technology consultations have you had for Chemical sensitivity?
0
1
2
3
4 or more
12)
What was the average percentage of relief you gained as a result?
75-100%
50-75%
25-50%
0-25%
Unsure
Comments
13)
Additional comments (up to 250 characters only)