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* 1. How much does the current EMF environment (cell phones/smart meters/wireless etc.) limit your lifestyle - your ability to work, shop, play, and or spend time with friends and family?

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* 2. Which of the following descriptions best matches how you would describe yourself?

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* 3. Please indicate the health problems you experience(d) and believe are related to EMF exposure. Check all that apply.

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* 4. Please indicate the EMF device(s), you believe caused or worsened your health problems. Check all that apply.

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* 5. Please indicate what if any of the following remediations have helped you to improve your health. Rate each of these according to helpfulness.

  Did not try Least helpful Somewhat helpful Helpful Most helpful
Prudent avoidance, or reducing EMF and RF exposure
Turning electricity off at the breaker box
Dietary changes
Nutritional or herbal supplements
Medical doctor
Sleeping on a non-metal bed
Shielding
Grounding/earthing, for example walking barefoot on the ground
Exercise
Prescription drugs
Acupuncture or Chiropractic
Massage, cranial sacral other alternative therapies
Counseling or therapy
EM filters, for example Stetzer filters
Dental amalgam removal
Heavy metal detox

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* 6. Anything else you'd like to add?

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