His Holiness
Maharishi
Mahesh Yogi
 
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Chemical sensitivities

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 sensitivities and its symptoms.
 Restricted or labored breathing  Wheezing
 Productive coughing  Aching lungs
 Runny nose  Sore throat
 Related to asthma  Related to allergy
 Worse in the winter  Worse in the spring
 Worse in the summer  Worse in the fall
 Aggravated by exercise  Aggravated by stress
 Allergic to animals  Food allergies
 Use inhaler  Have had life-threatening attacks
 Have been hospitalized for this disorder  Blocked energy flow
 Environmental allergies  Pesticides
 Dermatitis  Faintness
 Dizziness  Anaphylactic shock
 Irritable bowel syndrome  Digestive problems
 Peritonitis  None
2) (required) Check one or more primary areas to be addressed.
  Left Lung
  Right Lung
  Respiratory system
3) (required) Check one or more Sensations that are predominant in your case of Chemical sensitivities.
  Shakiness   Itching   Numbness   Heaviness   Weakness   Rawness
  Pain   Stiffness, rigidity and/or tightness   Burning   Heat   Tickling caused by Chemical sensitivitiesTickling
  None caused by Chemical sensitivitiesNone
4) Check one or more kinds of Pain that you experience in association with your case of Chemical sensitivities 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 sensitivities or its symptoms.
Frequency of Chemical sensitivities
6) (required) Currently, how severe is your case of Chemical sensitivities or its associated symptoms?
Duration of Chemical sensitivities     mild     moderate     severe     very severe
7) (required) How disabling is your case Chemical sensitivities or its symptoms?
Disablity from Chemical sensitivities  mildly  moderately  severely  very severely  Not at all
Disorder History
8) (required) Approximately, how long have you had Chemical sensitivities or its symptoms?
Duration of Chemical sensitivities  years  months  weeks
9) (required) Is your case of Chemical sensitivities the result of an accident or another sudden traumatic event?
Chemical sensitivities from accident yes  no  unsure
10) (required) Has your case of Chemical sensitivities been medically diagnosed?
Chemical sensitivities was medically diagnosed yes  no
11) Brief history of your case of Chemical sensitivities and its treatment  (optional - up to 250 characters only) 
History of Chemical sensitivities
12) How many prior 3-session Maharishi Vedic Vibration Technology consultations have you had for Chemical sensitivities?
Prior MVVT treatments for Chemical sensitivities  0  1  2  3  4 or more
12) What was the average percentage of relief you gained as a result?
Percent improvemnt through Chemical sensitivities  75-100%  50-75%  25-50%  0-25%  Unsure
Comments
13) Additional comments (up to 250 characters only)
Comments about Chemical sensitivities

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