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* 1. Thank you for taking part in our Research Programme! This technology is experimental and has been used safely and extensively since 2002. See here for more details.

We have a few questions for you (the person who has Dengue Fever). Your answers will help us to help you, and will be useful for our research.

Where did you grow up?

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* 2. Some people may feel unwell from things like:
Foods like dairy, gluten, caffeine, sugar.
Prescription or street drugs, alcohol, chemicals.
Mobile/cell phones, wi-fi, EMF.
Intense sound, light, busy environments (sensory overload).

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* 3. Personalising details: This information is used to personalise the Resonance for you.

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* 4. Dengue Fever

  No Yes - mild to moderate Yes - severe
Do you have a fever?
Are you unwell with other symptoms of Dengue Fever (e.g. vomiting, rash, pains, bleeding)?
Have you had Dengue Fever before?

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* 5. More about Dengue Fever

  Yes No N/A
If you have a fever, have you used any medication to bring down the fever?
Right now are you unwell with other symptoms of Dengue Fever (e.g. vomiting, rash, pains, bleeding)?

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* 6. How long have you had symptoms?

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* 7. Please rate the following symptoms from 0 to 10 where 10 is very severe.

  1 2 3 4 5 6 7 8 9 10
Rash
Headache and/or eye pain
Muscle, joint and/or bone pain
Nausea
Vomiting 
Vomiting blood, or blood in the stool 
Bleeding from the nose or gums 
Stomach/belly pain and/or tenderness
Feeling tired, restless, or irritable
Overall, how severe are your symptoms now?

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* 8. If female, are you pregnant?

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* 9. If you have had a platelet count or other tests done, please enter the results here. Also mention anything else you think it is important for us to know. Please provide an email address where we can contact you to hear how you are progressing.  

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* 10. Thank you for your replies.

Next steps:

  • Register on www.sourcemedicine.zone
  • Click 'Dengue Fever' on the homepage
  • Follow instructions to create and use your own Resonance link.

Informed Consent:
Information from this survey will be used anonymously by Source Medicine for our research. See full Informed Consent and Disclosure Statement here.



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