His Holiness
Maharishi
Mahesh Yogi
 
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Forgetfulness

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)

The Additional or Follow-up consultation is appropriate only if you are having the Enhanced Consultation at the same time, or have had it within the past 4 months.
You do not pay online. When the local Coordinator calls you to schedule your sessions, she will also take your payment information.
Issues
1) (required) Check one or more characteristics or information relevant to your current case of Forgetfulness and its symptoms.
 Poor memory  Short-term memory loss
 Long-term memory loss  Trouble remembering names and/or events
 Forgetfulness affecting self-confidence  Inability to maintain attention or concentrate
 Forgetfulness affecting schoolwork or job performance  Alzheimer's and/or dementia
 Anxiety  High blood pressure
 Blocked energy flow  None
2) (required) Check one or more primary areas to be addressed.
  Mind, Brain
3) (required) Check one or more Sensations that are predominant in your case of Forgetfulness.
  Shakiness   Itching   Numbness   Heaviness   Weakness   Rawness
  Pain   Stiffness, rigidity and/or tightness   Burning   Heat   None caused by ForgetfulnessNone
4) Check one or more kinds of Pain that you experience in association with your case of Forgetfulness 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 Forgetfulness or its symptoms.
Frequency of Forgetfulness
6) (required) Currently, how severe is your case of Forgetfulness or its associated symptoms?
Duration of Forgetfulness     mild     moderate     severe     very severe
7) (required) How disabling is your case Forgetfulness or its symptoms?
Disablity from Forgetfulness  mildly  moderately  severely  very severely  Not at all
Disorder History
8) (required) Approximately, how long have you had Forgetfulness or its symptoms?
Duration of Forgetfulness  years  months  weeks
9) (required) Is your case of Forgetfulness the result of an accident or another sudden traumatic event?
Forgetfulness from accident yes  no  unsure
10) (required) Has your case of Forgetfulness been medically diagnosed?
Forgetfulness was medically diagnosed yes  no
11) Brief history of your case of Forgetfulness and its treatment  (optional - up to 300 characters only) 
History of Forgetfulness
12) How many prior 3-session Maharishi Vedic Vibration Technology consultations have you had for Forgetfulness?
Prior MVVT treatments for Forgetfulness  0  1  2  3  4 or more
12) What was the average percentage of relief you gained as a result?
Percent improvemnt through Forgetfulness  75-100%  50-75%  25-50%  0-25%  Unsure
Comments
13) Additional comments (up to 300 characters only)
Comments about Forgetfulness

Submit treatment request for Forgetfulness
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