His Holiness
Maharishi
Mahesh Yogi
 
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Insomnia

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 Insomnia and its symptoms.
 Disturbed sleep  Associated with depression
 Associated with chronic fatigue  Headaches
 Due to physical pain and/or injury  Due to anxiety
 High blood pressure  Due to excitation
 Excessive thoughts or worry  Frequent urination
 Long term  Difficulty falling asleep
 Inability to remain asleep  Disturbed circadian rythms
 Afraid to fall asleep  Disturbed by ghosts
 Occasionally do not sleep at all  Light sleeper
 Witnessing sleep  Blocked energy flow
 None
2) (required) Check one or more primary areas to be addressed.
  Mind, Brain
  Whole physiology
3) (required) Check one or more Sensations that are predominant in your case of Insomnia.
  Shakiness   Itching   Numbness   Heaviness   Weakness   Rawness
  Pain   Stiffness, rigidity and/or tightness   Burning   Heat   None caused by InsomniaNone
4) Check one or more kinds of Pain that you experience in association with your case of Insomnia 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 Insomnia or its symptoms.
Frequency of Insomnia
6) (required) Currently, how severe is your case of Insomnia or its associated symptoms?
Duration of Insomnia     mild     moderate     severe     very severe
7) (required) How disabling is your case Insomnia or its symptoms?
Disablity from Insomnia  mildly  moderately  severely  very severely  Not at all
Disorder History
8) (required) Approximately, how long have you had Insomnia or its symptoms?
Duration of Insomnia  years  months  weeks
9) (required) Is your case of Insomnia the result of an accident or another sudden traumatic event?
Insomnia from accident yes  no  unsure
10) (required) Has your case of Insomnia been medically diagnosed?
Insomnia was medically diagnosed yes  no
11) Brief history of your case of Insomnia and its treatment  (optional - up to 250 characters only) 
History of Insomnia
12) How many prior 3-session Maharishi Vedic Vibration Technology consultations have you had for Insomnia?
Prior MVVT treatments for Insomnia  0  1  2  3  4 or more
12) What was the average percentage of relief you gained as a result?
Percent improvemnt through Insomnia  75-100%  50-75%  25-50%  0-25%  Unsure
Comments
13) Additional comments (up to 250 characters only)
Comments about Insomnia

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