The following outline
questions may assist you when compiling your ES health history:
Name & location & previous occupation: (for the avoidance of
duplication. When we compile these details into the document we will code these
details, such as F43lon, for female aged 43 and living in London)?
How long have you known you
are ES? How did you find this out?
Now that you know about ES
how long have you been experiencing ES symptoms?
ENVIRONMENT
Have you moved house recently
and if so, were you becoming ES at an earlier address and if so what were
the triggers? Does anyone else in your household suffer from similar symptoms?
Do your colleagues at work
have similar symptoms?
HEALTH
What is your current state
of health and how stable is this?
Please list your symptoms,
how often do these occur and what are your worst symptoms?
How helpful has your own
doctor been and have you been referred by your GP for tests for your ES
symptoms?
Please list any treatments
either conventional or complimentary that you have tried and which have or has
helped you.
LIFESTYLE
How has your life changed
since becoming ES, e.g. changes to your career and earning potential,
lifestyle, diet, friends, family, travel?
What are you now
regularly unable to do?
What have you done to adapt
your life e. g bought corded home phone, stopped using a mobile/computer/wifi
internet connection/ microwave oven, other?
Have you shielded your home
and or workplace? If so what shielding materials did you use.
Have you learnt anything
about being ES that you could share with other sufferers?
Please mention any useful
sources of information on ES, web sites, supplements/ clothing/ hand outs,
books which we could recommend to other ES.
Would you be prepared to have your case notes included anonymously
into a document, which will be used to raise awareness about electro
sensitivity? Please write any additional comments on a separate sheet.
Please sign and date this form:
MANY THANKS for your time and we look forward to having more ES
news for you soon.
sarahdacre@aol.com or for
snail mail post to me at
EMFatic solutions, P O Box 49747, LONDON N20 0XR