Mutational Profile


LIGHTBODY INTEGRATION MUTATIONAL PROFILE
Name:
Address:
Email:
Phone:
Postcode:
Which of the following symptoms have you been experiencing?

Check all that apply even if they have occurred only once since 1988

Headaches,if so where? back of head
base of skull forehead
cluster headaches migraines on the left side
migraines on the right side ocular migraine (pain begins at the back of the head and travels in a line up and over the head & circles one eye)
received impact to head of any kind e.g. whip lash, horse riding fall, concussion even prior to 1988 neck pain
shoulder pain muscle aches or joint aches
numbness, if so where? tingling, if so where?
loss of grip deep leg jerks and pain
vibrating while meditating or while falling asleep tones, beeps, music, or “electronic Morse code” in your ears
blurry vision double vision
hazy vision objects appearing to melt, shimmer, or move
seeing geometries, equations, bands of light, hieroglyphics, or fire letters in external or internal vision dizziness
“hot flashes” flu-like symptoms
changes in food habits excessive sensory input
memory loss inability to project forward in time
inability to communicate in sentences inability to comprehend what others are saying (audio dyslexia)
heart palpitations, arrhythmia, chest pains clumsiness
free floating anxiety sudden sense of being “lost”
sudden inability to make decisions seizures
intense déjà vu, If so how often? displacement: for a few seconds you are somewhere you have been before with full sensory experience,so strong you can smell the coffee. If so how often?
body jerks while drifting off to sleep shake when you wake up
so cold on the inside of your body that your teeth chatter, even though the room is warm cold hands and feet
hiatal hernia and/or acid reflux difficulty digesting food
low level irritation or depression extraordinary pain when you stub your toe
extreme panic feeling over a particular creature(e.g. snakes, spiders, bugs) coughing
pressure on the chest and forehead with tingling and numbness in the hands and arms deep fatigue, especially upon waking up in the morning
Headache in centre of head and/or radiant headache at jade pillow that can feel like a metal plate has been screwed to it. a feeling of wanting to die/leave the planet
allergies/arthritis hypersensitivity
feeling like an alien big change in personality/personal preferences
Is there anything else you think your practitioner should know?

  I understand that healing is not a medical treatment. I also appreciate that it is my responsibility to seek medical care for any problem or illness.