His Holiness
Maharishi
Mahesh Yogi
 
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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 caused by Chemical sensitivityNone
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.
Frequency of Chemical sensitivity
6) (required) Currently, how severe is your case of Chemical sensitivity or its associated symptoms?
Duration of Chemical sensitivity     mild     moderate     severe     very severe
7) (required) How disabling is your case Chemical sensitivity or its symptoms?
Disablity from Chemical sensitivity  mildly  moderately  severely  very severely  Not at all
Disorder History
8) (required) Approximately, how long have you had Chemical sensitivity or its symptoms?
Duration of Chemical sensitivity  years  months  weeks
9) (required) Is your case of Chemical sensitivity the result of an accident or another sudden traumatic event?
Chemical sensitivity from accident yes  no  unsure
10) (required) Has your case of Chemical sensitivity been medically diagnosed?
Chemical sensitivity was medically diagnosed yes  no
11) Brief history of your case of Chemical sensitivity and its treatment  (optional - up to 250 characters only) 
History of Chemical sensitivity
12) How many prior 3-session Maharishi Vedic Vibration Technology consultations have you had for Chemical sensitivity?
Prior MVVT treatments for Chemical sensitivity  0  1  2  3  4 or more
12) What was the average percentage of relief you gained as a result?
Percent improvemnt through Chemical sensitivity  75-100%  50-75%  25-50%  0-25%  Unsure
Comments
13) Additional comments (up to 250 characters only)
Comments about Chemical sensitivity

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