Allergy Survey finding a drug free solution

Allergy Survey

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Allergies , finding a drug free solution

Thank you for participating in our survey and gathering data to measure the effectiveness of this program. This is why we need you to fill in this survey before and after completing our program(s), to measure the changes.

When we refer to “Eating Normally” or “Using Normal Products” we mean that there is no avoidance of possible allergens.
If you have more than one person in your family with allergies and/or learning difficulties, then please fill in one questionnaire for each person who is listening to the Apphirmations.

Who should fill in this survey?

People who are participating in our trials
People who want to be eligible for our money back guarantee offer

Name*
Name* Surname*
Email*
Name and age of the person with learning difficulties and/ or allergies*
Gender*
Does your (child's) condition improve when you change the diet? Is yes, which foods do you eliminate?
What are your (child's) symptoms?*
Are you (or your child) allergic to anesthesia and/or penicillin?
Are you (or your child) allergic to any chemicals?
Are you (or your child) allergic to wheat, gluten or maize/corn?
Are you (or your child) allergic to eggs?
Are you (or your child) allergic to fish / shellfish?
Are you (or your child) allergic to nuts and/or sesame seeds?
Are you (or your child) allergic to milk products / ice cream?
Are you (or your child) allergic to food additives / colourants?*
Are you (or your child) allergic to animals?*
Do you (or your child) have strong reactions to insect bites?
Are you (or your child) allergic to bees?
What else are you (or your child) allergic for or struggling with. Rate on a scale of 1-5?*
Do you (or your child) experience abdominal bloating, irritable bowel syndrome or indigestion?
Do you (or your child) have constipation or diarrhoea when eating "normally"?
Do you (or your child) have acne or pimples?*
Do you (or your child) have lack of concentration, ADD / ADHD symptoms?*
Are you (or your child) anxious?
Do you (or your child) have asthma?*
Is your (or your child's) behaviour on the Asperger's to Autism Scale?*
Do you (or your child) wet the bed or have frequent urination?
Do you (or your child) have behavioural problems?
Did you (or your child) have ear infections as a young child, when eating "normally"?
Do you (or your child) have eczema when eating "normally "and using "normal" products?
Do you (or your child) have an auto-immune disorder?, e,g Lupus, Fibromyalgia, fatigue syndrome?
Do you (or your child) have headaches and/or migraines?*
Do you (or your child) have selective or poor memory?*
Are you (or your child) allergic to air-born allergens?*
Are you (or your child) allergic to dust mites?*
How many anti-histamine tablets do you take monthly?*
Disclaimer: We do not claim that our programs will remove all your (child's) symptoms. All our Apphirmation programs are used at your own risk and out of your own free will. If your child is on medication, is anaphylactic for certain allergens or has other medical conditions, it is advisable to work in conjunction with your health professional. Any changes in medication should be done in consultation with a health professional.*
- I have read the disclaimer and I agree

Go to our App User Guide to watch a few videos how to listen to the specialised Apphirmations

App User Guide