Submit a Case History

 

Name*

 

Email Address*

 

Phone Number

 

May we include your e-mail so people can contact you?

 

Choose One

Yes
No

 

If you are a practitioner presenting information about a client, do you either 1) have written permission in your files from the client for the case to be discussed in a public forum or have you 2) completely concealed the client's identity in your write-up? (Both are recommended.)

 

Choose One

Yes
No

 

Please describe the initial condition. Include any medical diagnosis before applying Energy Medicine and the date of that diagnosis. If available please provide, age, and other relevant information. Include specific and accurate details of the sequence of events with regard to the condition and any other medical treatment.

 

Initial Condition*

 

Please describe the Energy Medicine interventions that were used including the EM techniques employed and the frequency and sequence in which they were used.

 

Interventions*

 

Please describe the results. Include any medical diagnosis or assessment following the use of Energy Medicine.

 

Results

 

Was any other treatment used (medical or alternative)? If so, please describe.

 

Treatment

 

If you have any final comments or a particular conclusion you may enter it here.

 

Final Comments