Maharishi Mahesh Yogi
His Holiness Maharishi Mahesh Yogi

Application

Step 3 of 3: Application Form for a Consultation

Required fields are marked with stars: ***

Personal Information
*** Gender:
     

Where do you want to receive your MVVT consultation?

 

Please give details on the disorders for which you wish to have a consultation:

Required fields are marked with stars: ***

(not required when selecting Elimination of Pragyaparadh or
Enlivening the 40 aspects of Veda in physiology)

First Disorder



Pain, if any:
       
Has your disorder been medically diagnosed?
     
If "Yes", Date of Diagnosis:
     
Disorder has been present for (enter number):
       

(this information will be used only for evaluating the programme)
Second Disorder (if applicable)



Pain, if any:
       
Has your disorder been medically diagnosed?
     
If "Yes", Date of Diagnosis:
     
Disorder has been present for (enter number):
       

(this information will be used only for evaluating the programme)
Third Disorder (if applicable)



Pain, if any:
       
Has your disorder been medically diagnosed?
     
If "Yes", Date of Diagnosis:
     
Disorder has been present for (enter number):
       

(this information will be used only for evaluating the programme)

(If you wish to apply for more disorders, please fill out more applications like this.
Make sure that you give the same name as in this application.)