Hidden Infection Self Check List Part 2Horowitz/MSIDS 38 Point Symptom Checklist First Name * Last Name How can we apply to you? * Mr Mrs Ms Other How old are you? * Have you had a tick bite with no rash or flue like symptoms? * Never Sometimes Most of the time All of the time Not applicableYou have had a tick bite, an Erythema migrans or undefined rash, followed by flu-like symptoms? * Never Sometimes Most of the time All of the time Not applicableDo you experience migratory muscle pain? * Never Sometimes Most of the time All of the time Not applicableDo you experience migratory joint pain? * Never Sometimes Most of the time All of the time Not applicableDo you experience tingling/burning/numbness that migrates and/or comes and goes? * Never Sometimes Most of the time All of the time Not applicableDo you have received a prior diagnosis of Chronic Fatigue Syndrome or Fibromyalgia? * Never Sometimes Most of the time All of the time Not applicableDo you have received a prior diagnosis of a non specific autoimmune disorder (Lupus, MS, Rheumatoid Arthritis)? * Never Sometimes Most of the time All of the time Not applicableDo you have had a positive Lyme test (ELISA, Western Blot, PCR)? * Never Sometimes Most of the time All of the time Not applicable Email * Contact PHONE number starting with area code (Example: 357 99123456 or 61 - Australia or 44 - UK) GDRP Agreement. I consent to having this website my submitted information so they can respond to my inquiry * I agree SubmitΔStill not sure or have other questions? Enroll NLS Diagnostic session to analyse full body imbalances, hidden viruses and bacteria:Free Consultation Inquiry Form Name * First Last * Last Phone (example: 357950123456) * Email * I would like to receive Bio-resonance Cyprus News Letters * Yes Yes but not too oftenHow many years have you been experiencing symptoms of your primary concern? * 1 -5 year 5 - 10 years More than 10 years What is your primary diagnosis if known? Have you ever been misdiagnosed? * Yes NoHave you ever attempted to treat your symptoms? * Yes NoDo you know about Bioresonance/NLS diagnostics Analysis Program? * Yes NoDo you want us to send you Bioresonance/ NLS Diagnostics Full Guidance and contact you in person? * Yes NoDo you want to book Free Consultation and we call you back to agree on date and time? * Yes, call me back today (Hours: 08.30-20.00 on Mon-Fr and 10.00 -16.00 on Saturday) Yes, call me back tomorrow (Hours: 08.30-20.00 on Mon-Fr and 10.00 -16.00 on Saturday) I will get in touch laterGDRP Agreement. I consent to having this website store my submitted information so they can respond to my inquiry. * I agree I consent Text SubmitΔOr just write to us:Contact Us Name * First Last * Last Phone (example: 357960123456) * Email * Message * SubmitΔ