Please note! You must have JavaScript enabled to use our on line application
His Holiness
Maharishi
Mahesh Yogi
Whiplash
Main Category Index
Alphabetic Index
Whole body whiplash with associated trauma
Your answers will enable us to develop your personalized consultation.
Read carefully before proceeding:
Each initial consultation for Whole body whiplash with associated trauma requires 12 sessions. Subsequent consultations for Whole body whiplash with associated trauma may be taken in 3 sessions at the reduced fee. Click
here
for more information about consultation fees.
(required)
Indicate below if this is an initial (12-session) consultation or a repeat (3-session) consultation.
An initial consultation (12-session)
A repeat consultation (3-session)
Issues
1)
(required)
Check one or more
characteristics
or information relevant to your current case of Whole body whiplash with associated trauma and its symptoms.
Result of automobile accident
Result of other accident
Chronic back pain
Very tight muscles
Muscle spasms
Pain after lifting
Restricted mobility
Inhibits exercise
Worse during or after exercise
Feels improved during or after exercise
Confined to bed
Have had surgery to correct the problem
Have had chiropractic adjustments for the problem
Mobility of neck affected
Frequent headaches
Tension in neck and shoulders
Tingling and numbness down arms
General pain and stiffness
Injury to the pelvis, buttocks and/or coccyx
Sciatica
Concussion
Blocked energy flow
None
2)
(required)
Check one or more
primary areas
to be addressed.
Left Neck
Right Neck
Left Shoulder
Right Shoulder
Left Upper back
Right Upper back
Left Mid back
Right Mid back
Left Lower back
Right Lower back
Left Pelvis
Right Pelvis
Left Head
Right Head
Front Head
Back Head
Top Head
Left Upper extremities
Right Upper extremities
Left Lower extremities
Right Lower extremities
Whole body
3)
(required)
Check one or more
Sensations
that are predominant in your case of Whole body whiplash with associated trauma.
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 Whole body whiplash with associated trauma 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 Whole body whiplash with associated trauma or its symptoms.
Daily
Weekly
Monthly
Yearly
Continuously
Varies
Depends entirely on circumstances
6)
(required)
Currently,
how severe
is your case of Whole body whiplash with associated trauma or its associated symptoms?
mild
moderate
severe
very severe
7)
(required)
How
disabling
is your case Whole body whiplash with associated trauma or its symptoms?
mildly
moderately
severely
very severely
Not at all
Disorder History
8)
(required)
Approximately,
how long
have you had Whole body whiplash with associated trauma 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 Whole body whiplash with associated trauma the
result of an accident
or another sudden traumatic event?
yes
no
unsure
10)
(required)
Has your case of Whole body whiplash with associated trauma been
medically diagnosed?
yes
no
11)
Brief history of your case of Whole body whiplash with associated trauma and its treatment (optional - up to 250 characters only)
12)
How many prior 3-session Maharishi Vedic Vibration Technology consultations have you had for Whole body whiplash with associated trauma?
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)